Provider Demographics
NPI:1053039677
Name:BROWN, JAMELIA LA-KENYA (SUDCC IV)
Entity type:Individual
Prefix:
First Name:JAMELIA
Middle Name:LA-KENYA
Last Name:BROWN
Suffix:
Gender:F
Credentials:SUDCC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 VALE RD STE 14
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3848
Mailing Address - Country:US
Mailing Address - Phone:510-880-7145
Mailing Address - Fax:
Practice Address - Street 1:2089 VALE RD STE 14
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3848
Practice Address - Country:US
Practice Address - Phone:510-880-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7619101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)