Provider Demographics
NPI:1669698221
Name:BROWN, SHARON (PHD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
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 1:501 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCKENZIE
Mailing Address - State:AL
Mailing Address - Zip Code:36456-4141
Mailing Address - Country:US
Mailing Address - Phone:334-374-0018
Mailing Address - Fax:
Practice Address - Street 1:19815 BAY BRANCH RD
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-9234
Practice Address - Country:US
Practice Address - Phone:334-222-2525
Practice Address - Fax:334-222-4660
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL61-30332OtherUBH BASIC
AL61-40332OtherUBH PLUS