Provider Demographics
NPI:1902079122
Name:BROWN, KENNETH CURTIS JR (M-RAS, NCAC-1 CSC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CURTIS
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:M-RAS, NCAC-1 CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ASCOT DR STE D
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3400
Mailing Address - Country:US
Mailing Address - Phone:916-786-3750
Mailing Address - Fax:916-786-3750
Practice Address - Street 1:120 ASCOT DR STE D
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3400
Practice Address - Country:US
Practice Address - Phone:916-786-3750
Practice Address - Fax:916-786-3750
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
101YM0800X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program