Provider Demographics
NPI:1154899326
Name:BROWN, CHRISTINA LEE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEE
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 1:13439 RAVINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9180
Mailing Address - Country:US
Mailing Address - Phone:616-502-7129
Mailing Address - Fax:
Practice Address - Street 1:13439 RAVINE VIEW DR
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-9180
Practice Address - Country:US
Practice Address - Phone:616-502-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician