Provider Demographics
NPI:1033307178
Name:BROWN, ALICIA (MED)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:WITTENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:14507 ONEAL RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2411
Mailing Address - Country:US
Mailing Address - Phone:334-437-0706
Mailing Address - Fax:
Practice Address - Street 1:14507 ONEAL RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2411
Practice Address - Country:US
Practice Address - Phone:334-437-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1334A101YM0800X
MS621116103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling