Provider Demographics
NPI:1083589758
Name:BROWN BULLOCK, CARMELITA JEANETTE (CHW)
Entity type:Individual
Prefix:MS
First Name:CARMELITA
Middle Name:JEANETTE
Last Name:BROWN BULLOCK
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24060 MIDDLEBELT RD UNIT 28
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2978
Mailing Address - Country:US
Mailing Address - Phone:313-728-3442
Mailing Address - Fax:
Practice Address - Street 1:2617 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3330
Practice Address - Country:US
Practice Address - Phone:877-224-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty