Provider Demographics
NPI:1386144103
Name:BROWN, TEISHA PATRICIA (MA, NCC, LPC, CCTP)
Entity type:Individual
Prefix:
First Name:TEISHA
Middle Name:PATRICIA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, NCC, LPC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 N WANAMAKER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3828
Mailing Address - Country:US
Mailing Address - Phone:679-784-3212
Mailing Address - Fax:
Practice Address - Street 1:4919 PENTRIDGE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3320
Practice Address - Country:US
Practice Address - Phone:215-948-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011759101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional