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General NPI Number Information
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NPI Number | 1730995507
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Entity Type | Organization
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Legal Business Name | MANIFEST AND DREAM LLC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 2226 EAST LAKE AVENUE EAST #1103
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City | SEATTLE
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State | WA
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Zip | 98102
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Country | US
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Telephone | 206-800-8396
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Fax |
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Provider Business Mailing Address
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Address Line | 1752 NW MARKET ST # 4512
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City | SEATTLE
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State | WA
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Zip | 98107-5264
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Country | US
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Telephone | 206-800-8396
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMILA M BROWN
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Credential | PSYD
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Telephone | 206-745-0704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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