MEDICARE: MS. KENDRA BROWN-DONETH LPC, NCC, CAAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401007800	MI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	C-00348	MI
3	101YP2500X	Professional Counselor	66748

General Provider Information

NPI Number	:	1578693990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KENDRA BROWN-DONETH LPC, NCC, CAAC

Provider Business Mailing Address
First Line	:	20651 W WARREN ST
Second Line	:	MYRIAM HOUSE
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2622
Country	:	US
Telephone Number	:	313-271-3050
Fax Number	:	313-441-5247

Provider Business Practice Location Address
First Line	:	20651 W WARREN ST
Second Line	:	MYRIAM HOUSE
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2622
Country	:	US
Telephone Number	:	313-271-3050
Fax Number	:	313-441-5247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	11/13/2009

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