Provider Demographics
NPI:1306291778
Name:BROWN, DESHON TERIL SR (CDAC1,CPAC)
Entity type:Individual
Prefix:MR
First Name:DESHON
Middle Name:TERIL
Last Name:BROWN
Suffix:SR
Gender:M
Credentials:CDAC1,CPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HOWE AVE BLDG 400-A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4731
Mailing Address - Country:US
Mailing Address - Phone:916-441-0123
Mailing Address - Fax:916-441-6893
Practice Address - Street 1:650 HOWE AVE BLDG 400-A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-441-0123
Practice Address - Fax:916-441-6893
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)