Basic Information
| Provider Information | |||||||||
| NPI: | 1881630598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 E UNION ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286553449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284339190 | ||||||||
| FaxNumber: | 8284339130 | ||||||||
| Practice Location | |||||||||
| Address1: | 78 MEDICAL CENTER DRIVE | ||||||||
| Address2: | AUGUSTA HEALTHCARE CROSSROADS | ||||||||
| City: | FISHERSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402132525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 01/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0701005023 | VA | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 6104169 | 05 | NC | MEDICAID | 43178 | 01 | NBCC | OTHER |