Provider Demographics
NPI:1194300962
Name:BROWN, CARLA ANDRANETTE
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ANDRANETTE
Last Name:BROWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 PAUTONE TRCE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-6539
Mailing Address - Country:US
Mailing Address - Phone:313-318-5517
Mailing Address - Fax:
Practice Address - Street 1:5641 SHADOW VIEW DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2953
Practice Address - Country:US
Practice Address - Phone:313-318-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional