1588782072 NPI number — MS. AMY WHITLEY BROWN LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588782072 NPI number — MS. AMY WHITLEY BROWN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
AMY
Provider Middle Name:
WHITLEY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
AMY
Provider Other Middle Name:
W
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588782072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUIES CREEK
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-893-5727
Provider Business Mailing Address Fax Number:
910-893-6404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5841 US HWY 421 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LILLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-893-5727
Provider Business Practice Location Address Fax Number:
910-893-6404
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6106891 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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