Provider Demographics
NPI:1841997491
Name:BROWN, ELIZABETH BULLA (LCMHCA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BULLA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2050
Mailing Address - Country:US
Mailing Address - Phone:336-272-0855
Mailing Address - Fax:
Practice Address - Street 1:1501 HIGHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2050
Practice Address - Country:US
Practice Address - Phone:336-272-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health