Provider Demographics
NPI:1720740145
Name:BROWN, TYIESHA (LMHC)
Entity Type:Individual
Prefix:
First Name:TYIESHA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TYIESHA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LHMC
Mailing Address - Street 1:2203 EDUCATION WAY # 2203
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-3429
Mailing Address - Country:US
Mailing Address - Phone:470-767-6803
Mailing Address - Fax:
Practice Address - Street 1:2203 EDUCATION WAY # 2203
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3429
Practice Address - Country:US
Practice Address - Phone:470-767-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health