Provider Demographics
NPI:1124484100
Name:BROWN, LINDA (NBCC, LPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:NBCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 WAY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-9330
Mailing Address - Country:US
Mailing Address - Phone:601-573-7574
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY STE 5203
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2079
Practice Address - Country:US
Practice Address - Phone:601-573-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09056741Medicaid