Individual provider Active NPI

M. D. Brown, PH.D, LPC, NCC, CPSC

  • Professional Counselor
  • Brookhaven, GA
National Provider Identifier
1023470291
Registry record updated Mar 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC005770 Issued in GA
Practice address
4060 Peachtree Rd NE
Suite D-423
Brookhaven, GA 30319-3020
Phone
(770) 833-3938
Fax
(404) 237-1355
NPI assigned
Mar 25, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC005770 GA Primary

Addresses

Primary practice location

4060 Peachtree Rd NE
Suite D-423
Brookhaven, GA 30319-3020

Mailing address

4060 Peachtree Rd NE
Suite D-423
Brookhaven, GA 30319-3020
Phone (770) 833-3938

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
LPC005770GAMDProfessional Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458864000000",
    "number": "1023470291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 PEACHTREE RD NE",
            "address_2": "SUITE D-423",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303193020",
            "telephone_number": "770-833-3938",
            "fax_number": "404-237-1355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 PEACHTREE RD NE",
            "address_2": "SUITE D-423",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303193020",
            "telephone_number": "770-833-3938",
            "fax_number": "404-237-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "M.",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "PH.D, LPC, NCC, CPSC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-25",
        "last_updated": "2016-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC005770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookhaven, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.