Provider Demographics
NPI:1881962413
Name:BROWN-GORDON, JOANNA KYRIE (LMSW, MA)
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:KYRIE
Last Name:BROWN-GORDON
Suffix:
Gender:F
Credentials:LMSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17135 WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3533
Mailing Address - Country:US
Mailing Address - Phone:248-225-2618
Mailing Address - Fax:313-977-9296
Practice Address - Street 1:30100 TELEGRAPH RD STE 474
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-5810
Practice Address - Country:US
Practice Address - Phone:248-914-4607
Practice Address - Fax:313-977-9296
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010895461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical