Provider Demographics
NPI:1689163826
Name:BROWN, CORINNE M (BCBA)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 JOHN GODLEY LN
Mailing Address - Street 2:
Mailing Address - City:ELLABELL
Mailing Address - State:GA
Mailing Address - Zip Code:31308-8076
Mailing Address - Country:US
Mailing Address - Phone:770-870-0770
Mailing Address - Fax:
Practice Address - Street 1:191 JOHN GODLEY LN
Practice Address - Street 2:
Practice Address - City:ELLABELL
Practice Address - State:GA
Practice Address - Zip Code:31308-8076
Practice Address - Country:US
Practice Address - Phone:770-870-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid