Provider Demographics
NPI:1285809368
Name:BROWN, DEBRA FULLER (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:FULLER
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 OAK KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3090
Mailing Address - Country:US
Mailing Address - Phone:770-484-1863
Mailing Address - Fax:
Practice Address - Street 1:1198 OAK KNOLL CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3090
Practice Address - Country:US
Practice Address - Phone:770-484-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0024111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical