Provider Demographics
NPI:1508322322
Name:BROWN-MINGO, ELAINA (LMSW-C)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:BROWN-MINGO
Suffix:
Gender:F
Credentials:LMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21063
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-0063
Mailing Address - Country:US
Mailing Address - Phone:615-852-9737
Mailing Address - Fax:
Practice Address - Street 1:17567 HUBBELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2708
Practice Address - Country:US
Practice Address - Phone:313-985-0243
Practice Address - Fax:313-985-1043
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-17
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011037751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical