Kendal Simeon Brown, LCAS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCAS-25015 Issued in NC

Practice address

4830 Tutelo TRL
Winston Salem, NC 27127-9419

Phone

(540) 629-3308

NPI assigned

Jun 9, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1560038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560038400000",
    "number": "1356900898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4830 TUTELO TRL",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271279419",
            "telephone_number": "540-629-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4830 TUTELO TRL",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271279419",
            "telephone_number": "540-629-3308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "KENDAL",
        "middle_name": "SIMEON",
        "credential": "LCAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-09",
        "last_updated": "2019-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-25015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LCAC-25015",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "simeon107@hotmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4830 Tutelo Trl",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271279419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jason Brown, PA-C
• Jennifer Brown
• Jonathan Brown
• Karen Hammond Brown, LPC
• Kelly Brown
• Kimberly Evonne Brown, LCSWA
• Lauren Brooke Brown, FNP
• Malcolm McDougal Brown, M.D.
• Marcel Gerard Brown
• Molly Brown

• All providers in Winston Salem, NC
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2019; 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.