Basic Information
Provider Information
NPI: 1598172959
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: LAWANA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2106 LOOP RD
Address2:  
City: WINNSBORO
State: LA
PostalCode: 712953344
CountryCode: US
TelephoneNumber: 3184125265
FaxNumber: 3184353842
Practice Location
Address1: 2106 LOOP RD
Address2:  
City: WINNSBORO
State: LA
PostalCode: 712953344
CountryCode: US
TelephoneNumber: 3184125265
FaxNumber: 3184353842
Other Information
ProviderEnumerationDate: 07/17/2014
LastUpdateDate: 07/17/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X6964LAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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