Provider Demographics
NPI:1861165177
Name:BROWN, KALLIE DANIELLE (LCMHCA)
Entity type:Individual
Prefix:
First Name:KALLIE
Middle Name:DANIELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9613
Mailing Address - Country:US
Mailing Address - Phone:828-974-2144
Mailing Address - Fax:
Practice Address - Street 1:150 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9613
Practice Address - Country:US
Practice Address - Phone:828-974-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional