Healthcare Provider Details

I. General information

NPI: 1730095811
Provider Name (Legal Business Name): CARMON D BROWN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27333 ACACIA ST
HARRISON TOWNSHIP MI
48045-2503
US

IV. Provider business mailing address

27333 ACACIA ST
HARRISON TOWNSHIP MI
48045-2503
US

V. Phone/Fax

Practice location:
  • Phone: 313-418-0911
  • Fax:
Mailing address:
  • Phone: 313-418-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP0000000801453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: