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General NPI Number Information
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NPI Number | 1508379397
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Entity Type | Organization
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Legal Business Name | JOLIE J. BROWN, LMSW LLC
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 4519 CASCADE RD SE STE 4
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8319
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Country | US
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Telephone | 616-244-2218
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Fax | 616-469-2891
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Provider Business Mailing Address
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Address Line | 4519 CASCADE RD. SE BUILDING 1, SUITE 4
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City | GRAND RAPIDS
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State | MI
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Zip | 49546
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Country | US
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Telephone | 616-244-2218
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Fax | 616-469-2891
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. JOLIE BROWN
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Credential | LMSW
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Telephone | 773-266-1066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6801092311
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License Number State | MI
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