Provider Demographics
NPI:1972959716
Name:BROWN, TIKKI
Entity type:Individual
Prefix:
First Name:TIKKI
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6958 TIMBERS EAST LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6074
Mailing Address - Country:US
Mailing Address - Phone:770-912-6347
Mailing Address - Fax:770-742-0265
Practice Address - Street 1:6958 TIMBERS EAST LN
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6074
Practice Address - Country:US
Practice Address - Phone:770-912-6347
Practice Address - Fax:770-742-0862
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0037271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical