Individual
SHANIEQUA BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
153 BULL HILL LN, SUITE 321, WEST HAVEN, CT 06516-3928
(999) 999-9999
Mailing address
153 BULL HILL LN, SUITE 321, WEST HAVEN, CT 06516-3928
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1170
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008062470
BROWN MEDICAID #
CT
Enumeration date
11/04/2015
Last updated
08/08/2016
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