Kalisha Koran Brown, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27822-C Issued in AR

Practice address

2500 Rike Dr
Pine Bluff, AR 71603-3937

Phone

(870) 534-1834

Fax

(870) 534-5798

NPI assigned

Jul 3, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Kalisha Koran Vault Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Breaking Cycles Counseling

  • Clinical Social Worker
  • Grand Terrace, CA
  • NPI 1972284958
  Medicare reassignment Authorized official
• Sac Health System

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1013935923
  Medicare reassignment NPD
• Sac Health System

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1467274126
  NPD
• Sac Health System

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1801270137
  NPD

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

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788825600000",
    "number": "1396307070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 497",
            "city": "AUGUSTA",
            "state": "AR",
            "postal_code": "720060497",
            "telephone_number": "870-347-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RIKE DR",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716033937",
            "telephone_number": "870-534-1834",
            "fax_number": "870-534-5798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12139 Mount Vernon Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "Grand Terrace",
            "state": "CA",
            "postal_code": "923135500",
            "country_code": "US",
            "telephone_number": "909-222-0096",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "901 N Glebe Rd Fl 5",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "VA",
            "postal_code": "222031853",
            "country_code": "US",
            "telephone_number": "909-222-0096",
            "fax_number": "840-600-3050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3010 S Dakota St",
            "address_purpose": "LOCATION",
            "city": "Pine Bluff",
            "state": "AR",
            "postal_code": "716017208",
            "country_code": "US",
            "telephone_number": "909-222-0096 x09393",
            "fax_number": "840-600-3050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "KALISHA KORAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-03",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904013051",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "99995",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "118560",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "27822-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KALISHA KORAN",
            "last_name": "VAULT",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anthony A Brown, BS
• Cynthia Brown, SLP
• Donna Brown
• Glen Dale Brown Jr., D.C.
• Jamie Brown
• Kimberly R Brown, PLMSW
• Sarah Katherine Brown, ANP
• Toshia Brown
• Joseph E. Browning, MD
• Robin Browning, MSSLP.CCC

• Clinical Social Worker in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.