Provider Demographics
NPI:1730617309
Name:BROWN, MARQUITTA SONJA (CAC II)
Entity type:Individual
Prefix:
First Name:MARQUITTA
Middle Name:SONJA
Last Name:BROWN
Suffix:
Gender:F
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14231 E 4TH AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8720
Mailing Address - Country:US
Mailing Address - Phone:303-856-3485
Mailing Address - Fax:303-856-3175
Practice Address - Street 1:14231 E 4TH AVE STE 370
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8720
Practice Address - Country:US
Practice Address - Phone:303-856-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB0006908101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)