Provider Demographics
NPI:1063586253
Name:BROWN, WILLIAM WADE (HSP-PA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WADE
Last Name:BROWN
Suffix:
Gender:M
Credentials:HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-9671
Mailing Address - Country:US
Mailing Address - Phone:828-443-9486
Mailing Address - Fax:828-433-1793
Practice Address - Street 1:1435 MEADOW LN
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-9671
Practice Address - Country:US
Practice Address - Phone:828-443-9486
Practice Address - Fax:828-433-1793
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TC1900X
NC541103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107070Medicaid