Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | P744 | NE |
Y | 101YM0800X | Mental Health Counselor | 8653 | NE |
NPI | 1003107129 |
---|---|
Provider Name | Mr. Dwight Brown JR. |
First Address | Lincoln, NE 68510-3335 |
Second Address | Lincoln, NE 68516-6404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2011 |
Last Update Date | 23/04/2011 |