Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701008332 | VA |
N | 101YP2500X | Professional Counselor | 414 | CA |
NPI | 1003138165 |
---|---|
Provider Name | Addie Mae Brown |
First Address | Woodbridge, VA 22192-2846 |
Second Address | Woodbridge, VA 22192-2846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2010 |
Last Update Date | 31/10/2019 |