Provider Demographics
NPI:1306297742
Name:BROWN, TOMELLA (LLBSW)
Entity type:Individual
Prefix:MS
First Name:TOMELLA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17137 TEPPERT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3841
Mailing Address - Country:US
Mailing Address - Phone:313-485-6676
Mailing Address - Fax:
Practice Address - Street 1:17137 TEPPERT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3841
Practice Address - Country:US
Practice Address - Phone:313-485-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088913101YA0400X
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other