Organization
BRAVE DEFIANCE CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJA DIONNA KING (AO)
(205) 451-7955
Entity
Organization
Contact information
Practice address
6312 WELCOME AVE N, BROOKLYN PARK, MN 55429-2047
(205) 451-7955
Mailing address
6312 WELCOME AVE N, BROOKLYN PARK, MN 55429-2047
(612) 470-1783
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
0
—
Enumeration date
02/11/2022
Last updated
04/03/2026
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