Provider Demographics
NPI:1629880638
Name:BROWN, GERAVIS ANTOINE (MA, LMHP-R)
Entity type:Individual
Prefix:MR
First Name:GERAVIS
Middle Name:ANTOINE
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA, LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 BIG BEAR LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1470
Mailing Address - Country:US
Mailing Address - Phone:757-644-9191
Mailing Address - Fax:
Practice Address - Street 1:708 S ROSEMONT RD STE 203
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4061
Practice Address - Country:US
Practice Address - Phone:757-431-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional