Provider Demographics
NPI:1932454378
Name:BROWN, AMANDA F (LAC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:F
Last Name:BROWN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 LOCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5116
Mailing Address - Country:US
Mailing Address - Phone:336-575-1878
Mailing Address - Fax:
Practice Address - Street 1:1623 YORK AVE
Practice Address - Street 2:STE 103
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2311
Practice Address - Country:US
Practice Address - Phone:336-841-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC589171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist