# GODDESS GREAT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104435460
- **Authorized official:** KYMALETHA BROWN LLPC (COORDINATOR)
- **Authorized official phone:** (269) 414-5907

## Contact information

- **Practice address:** 17169 E WARREN AVE, DETROIT, MI 48224-2279
- **Practice address phone:** (313) 856-9192
- **Mailing address:** 10728 DUPREY ST, DETROIT, MI 48224-1295
- **Mailing address phone:** (269) 414-5907

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/23/2020
- **Last updated:** 01/20/2022