Provider Demographics
NPI:1952778540
Name:BROWN, KARISSA
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 DELL RD
Mailing Address - Street 2:APT D
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-8155
Mailing Address - Country:US
Mailing Address - Phone:517-748-0888
Mailing Address - Fax:
Practice Address - Street 1:2109 RAY ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3227
Practice Address - Country:US
Practice Address - Phone:517-748-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility