Provider Demographics
NPI:1811710429
Name:BROWN, ARETHA LYNETTE
Entity type:Individual
Prefix:
First Name:ARETHA
Middle Name:LYNETTE
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 1:1633 E BIANCHI RD APT 28
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-7602
Mailing Address - Country:US
Mailing Address - Phone:209-373-0358
Mailing Address - Fax:
Practice Address - Street 1:1341 W ROBINHOOD DR STE B1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5518
Practice Address - Country:US
Practice Address - Phone:209-373-0358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health