Healthcare Provider Details

I. General information

NPI: 1730570151
Provider Name (Legal Business Name): NICOLE BROWN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE BROWN VASHON LLP

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WASHINGTON AVE STE 320
GRAND HAVEN MI
49417-1378
US

IV. Provider business mailing address

2215 29TH ST SE STE B8A
GRAND RAPIDS MI
49508-1565
US

V. Phone/Fax

Practice location:
  • Phone: 616-690-5396
  • Fax: 616-404-7004
Mailing address:
  • Phone: 616-690-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401017587
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: