Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 72 | NC |
NPI | 1205080793 |
---|---|
Provider Name | Ms. Jennifer Clarke Brown |
First Address | Raleigh, NC 27609-4389 |
Second Address | Raleigh, NC 27609-4389 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2008 |
Last Update Date | 10/11/2008 |