Basic Information
| Provider Information | |||||||||
| NPI: | 1568882827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | KENNETH | ||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7225 MARINERS LANDING DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283067479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146801018 | ||||||||
| FaxNumber: | 9105708826 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 ARSENAL AVENUE | ||||||||
| Address2: | SUITE | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103233368 | ||||||||
| FaxNumber: | 9104867000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2014 | ||||||||
| LastUpdateDate: | 07/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A10683 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.