Organization Active NPI

Brave Defiance Consulting LLC

  • Community/Behavioral Health Agency
  • Brooklyn Park, MN
National Provider Identifier
1003560681
Registry record updated Apr 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BRAVE DEFIANCE CONSULTING LLC
Practice address
6312 Welcome Ave N
Brooklyn Park, MN 55429-2047
Phone
(205) 451-7955
NPI assigned
Feb 11, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Aja Dionna KingNPI 1821423740
Title
Ao
Phone
(205) 451-7955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

6312 Welcome Ave N
Brooklyn Park, MN 55429-2047

Mailing address

6312 Welcome Ave N
Brooklyn Park, MN 55429-2047
Phone (612) 470-1783

Other identifiers 1

IdentifierTypeStateIssuer
0Other0

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL adkingaking@gmail.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260504004760 MN Part B Supplier - Clinic/Group Practice 4688142169 Receives reassigned benefits from 1 practitioner
Practice locations: Brooklyn Park, MN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775174400000",
    "number": "1003560681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6312 WELCOME AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554292047",
            "telephone_number": "612-470-1783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6312 WELCOME AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554292047",
            "telephone_number": "205-451-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAVE DEFIANCE CONSULTING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-11",
        "last_updated": "2026-04-03",
        "certification_date": "2026-04-03",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "AJA",
        "authorized_official_middle_name": "DIONNA",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "205-451-7955"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "adkingaking@gmail.com",
            "affiliation": "N",
            "address_1": "6312 Welcome Ave N",
            "city": "Brooklyn Park",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554292047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.