Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | P007406 | NC |
NPI | 1003151697 |
---|---|
Provider Name | Anastashia Natasha Brown |
First Address | Charlotte, NC 28209-2682 |
Second Address | Charlotte, NC 28209-2682 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2012 |
Last Update Date | 07/12/2012 |