Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor |
NPI | 1295961852 |
---|---|
Provider Name | Stacey Mckinnie Brown |
First Address | Paradise, CA 95969-3280 |
Second Address | Eureka, CA 95503-8938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 12/04/2012 |