Provider Demographics
NPI:1881398220
Name:BROWN, KIYANIA (NCC, LCMHC)
Entity type:Individual
Prefix:
First Name:KIYANIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 FORKED OAK WAY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-8637
Mailing Address - Country:US
Mailing Address - Phone:980-785-4576
Mailing Address - Fax:
Practice Address - Street 1:204 FORKED OAK WAY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-8637
Practice Address - Country:US
Practice Address - Phone:980-785-4576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health