Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810003970 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810003970 | VA |
N | 103G00000X | Clinical Psychologist | 3835 | AZ |
N | 103TC0700X | Clinical Psychologist | 3835 | AZ |
NPI | 1003052457 |
---|---|
Provider Name | Dr. Demetria C. Brown |
First Address | Chester, VA 23831-1702 |
Second Address | Chester, VA 23831-1702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2009 |
Last Update Date | 13/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003052457 | (05) | VA |