Healthcare Provider Details

I. General information

NPI: 1861160665
Provider Name (Legal Business Name): DIANA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22101 MOROSS RD
DETROIT MI
48236-2148
US

IV. Provider business mailing address

9069 DIXIE HWY
IRA MI
48023-2409
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4000
  • Fax:
Mailing address:
  • Phone: 586-945-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: