Provider Demographics
NPI:1790507309
Name:BROWN, ADALIAH D (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:ADALIAH
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 S MAPLE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-1681
Mailing Address - Country:US
Mailing Address - Phone:317-360-5355
Mailing Address - Fax:
Practice Address - Street 1:412 S MAPLE ST STE 103
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-1681
Practice Address - Country:US
Practice Address - Phone:317-360-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88002384A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health