Provider Demographics
NPI:1508379397
Name:JOLIE J. BROWN, LMSW LLC
Entity Type:Organization
Organization Name:JOLIE J. BROWN, LMSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:773-266-1066
Mailing Address - Street 1:4519 CASCADE RD. SE
Mailing Address - Street 2:BUILDING 1, SUITE 4
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-244-2218
Mailing Address - Fax:616-469-2891
Practice Address - Street 1:4519 CASCADE RD SE STE 4
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8319
Practice Address - Country:US
Practice Address - Phone:616-244-2218
Practice Address - Fax:616-469-2891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092311261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)