Provider Demographics
NPI:1508012212
Name:BROWN, JOANN CHERYEL (BA, LSW)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:CHERYEL
Last Name:BROWN
Suffix:
Gender:F
Credentials:BA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20005 MANSFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2371
Mailing Address - Country:US
Mailing Address - Phone:313-207-3636
Mailing Address - Fax:
Practice Address - Street 1:23700 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1600
Practice Address - Country:US
Practice Address - Phone:586-758-6670
Practice Address - Fax:586-758-0243
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802084543101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500371Medicaid