Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 500044 | MI |
NPI | 1003914805 |
---|---|
Provider Name | Mrs. Karen S. Brooks |
First Address | Chesterfield, MI 48051-1252 |
Second Address | Memphis, MI 48041-1038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |