Provider Demographics
NPI:1487732780
Name:BROWN, VICKI-LYNN (MSW, LCSW, CCM)
Entity type:Individual
Prefix:MS
First Name:VICKI-LYNN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSW, LCSW, CCM
Other - Prefix:MS
Other - First Name:VICKI-LYNN
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW, CCM
Mailing Address - Street 1:5445 PAGEFORD DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5879
Mailing Address - Country:US
Mailing Address - Phone:919-741-0497
Mailing Address - Fax:
Practice Address - Street 1:5445 PAGEFORD DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5879
Practice Address - Country:US
Practice Address - Phone:919-741-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0029682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002236Medicaid
OTH000Medicare UPIN
NC6002236Medicaid