Individual
JAY BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADAC II
Contact information
Practice address
203 N STATE ST, NORTH VERNON, IN 47265-2454
(812) 200-2714
Mailing address
203 N STATE ST, NORTH VERNON, IN 47265-2454
(812) 200-2714
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CII2134
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CII2134
—
IN
Enumeration date
12/16/2018
Last updated
12/16/2018
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