Organization
GODDESS GREAT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYMALETHA BROWN LLPC (COORDINATOR)
(269) 414-5907
Entity
Organization
Contact information
Practice address
17169 E WARREN AVE, DETROIT, MI 48224-2279
(313) 856-9192
Mailing address
10728 DUPREY ST, DETROIT, MI 48224-1295
(269) 414-5907
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
07/23/2020
Last updated
01/20/2022
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