Healthcare Provider Details

I. General information

NPI: 1508012212
Provider Name (Legal Business Name): JOANN CHERYEL BROWN BA, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23700 VAN DYKE AVE
WARREN MI
48089-1600
US

IV. Provider business mailing address

20005 MANSFIELD ST
DETROIT MI
48235-2371
US

V. Phone/Fax

Practice location:
  • Phone: 586-758-6670
  • Fax: 586-758-0243
Mailing address:
  • Phone: 313-207-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6802084543
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: