Organization
THE GREAT DIVINE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYMALETHA BROWN LLPC (COUNSELOR/OWNER)
(313) 480-4766
Entity
Organization
Contact information
Practice address
17169 E WARREN AVE, DETROIT, MI 48224-2279
(313) 480-4766
Mailing address
17163 E WARREN AVE, DETROIT, MI 48224-2279
(313) 480-4766
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
01/20/2022
Last updated
01/20/2022
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