Provider Demographics
NPI:1871073064
Name:BROWN, ABIGAIL CARYSSA (LCSW)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CARYSSA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 ALGOMA RD
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24067-3407
Mailing Address - Country:US
Mailing Address - Phone:920-559-8502
Mailing Address - Fax:
Practice Address - Street 1:855 ALGOMA RD
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:VA
Practice Address - Zip Code:24067-3407
Practice Address - Country:US
Practice Address - Phone:920-559-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
VA09040158261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker