Individual
TERRELL JERMAINE BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, MA, LCAC
Contact information
Practice address
1690 BROADWAY BLD 19, SUITE 10, FORT WAYNE, IN 46802
(260) 409-8432
Mailing address
1690 BROADWAY BLD 19, SUITE 10, FORT WAYNE, IN 46802
(260) 409-8432
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001772A
IN
Other
Enumeration date
06/12/2024
Last updated
08/06/2024
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