Provider Demographics
NPI:1750753901
Name:BROWN, ROSALYN PORTER
Entity type:Individual
Prefix:MRS
First Name:ROSALYN
Middle Name:PORTER
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653-0514
Mailing Address - Country:US
Mailing Address - Phone:601-384-7486
Mailing Address - Fax:
Practice Address - Street 1:1644 CARTER ST # B
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3143
Practice Address - Country:US
Practice Address - Phone:318-414-3065
Practice Address - Fax:318-414-3067
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health