Provider Demographics
NPI:1821588773
Name:BROWN, AVERY JR (MA, LPC, CAADC)
Entity Type:Individual
Prefix:MR
First Name:AVERY
Middle Name:
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 TOWNSEND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-2331
Mailing Address - Country:US
Mailing Address - Phone:313-579-5824
Mailing Address - Fax:313-579-5861
Practice Address - Street 1:8333 TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-2331
Practice Address - Country:US
Practice Address - Phone:313-579-5824
Practice Address - Fax:313-579-5861
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-01659101YA0400X
MI6401012256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)