Basic Information
| Provider Information | |||||||||
| NPI: | 1477281277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WILLIAMSON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2527 COVE POINT PL | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234543269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574067485 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 222 W 19TH ST | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235172218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579415305 | ||||||||
| FaxNumber: | 7576408402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2022 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904001121 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.