Provider Demographics
NPI:1992058440
Name:KNOX, BRITTANY NICOLE (DLLP, LLMSW)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICOLE
Last Name:KNOX
Suffix:
Gender:F
Credentials:DLLP, LLMSW
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:NICOLE
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5992 WILLOWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-7133
Mailing Address - Country:US
Mailing Address - Phone:734-368-5631
Mailing Address - Fax:
Practice Address - Street 1:120 N HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2610
Practice Address - Country:US
Practice Address - Phone:734-368-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094042104100000X
MI6301017344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker