Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCDCIII.161671 | OH |
Y | 101YP2500X | Professional Counselor | E.2001660 | OH |
NPI | 1003233347 |
---|---|
Provider Name | Monique T Baker-Brown |
First Address | Youngstown, OH 44509-1227 |
Second Address | Youngstown, OH 44509-1227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 25/02/2020 |