Provider Demographics
NPI:1194261628
Name:BROWN, NIESHIA (ALC)
Entity type:Individual
Prefix:
First Name:NIESHIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:NIESHIA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-0655
Mailing Address - Country:US
Mailing Address - Phone:205-960-5820
Mailing Address - Fax:205-236-7241
Practice Address - Street 1:2712 WOODVIEW CIR
Practice Address - Street 2:APT. 607
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3541
Practice Address - Country:US
Practice Address - Phone:205-960-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2302A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health