=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700339850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANNETTE BROWN MA, LLPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2016
-----------------------------------------------------
Last Update Date | 07/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58089 MAIN ST SUITE A & B
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48048-2697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-604-9101
-----------------------------------------------------
Fax | 586-690-4902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58089 MAIN ST SUITE A & B
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48048-2697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 6401015549
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------