Provider Demographics
NPI:1528847803
Name:BROWN, TERRENCE CEDRIC (LGPC)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:CEDRIC
Last Name:BROWN
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 CHAPEL LAKE DR APT 303
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1664
Mailing Address - Country:US
Mailing Address - Phone:240-305-1975
Mailing Address - Fax:
Practice Address - Street 1:2607 CHAPEL LAKE DR APT 303
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1664
Practice Address - Country:US
Practice Address - Phone:240-305-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14357101YP1600X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional