The Great Divine Center LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

THE GREAT DIVINE CENTER LLC

Practice address

17169 E Warren Ave
Detroit, MI 48224-2279

Phone

(313) 480-4766

NPI assigned

Jan 20, 2022

Last updated

Jan 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kymaletha Brown, LLPCNPI 1407371529

Title

Counselor/Owner

Phone

(313) 480-4766

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kymaletha Rochelle Brown

  • Professional Counselor
  • Detroit, MI
  • NPI 1407371529

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1902558091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17163 E WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482242279",
            "telephone_number": "313-480-4766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17169 E WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482242279",
            "telephone_number": "313-480-4766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GREAT DIVINE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-08",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KYMALETHA",
        "authorized_official_title_or_position": "COUNSELOR/OWNER",
        "authorized_official_telephone_number": "313-480-4766",
        "authorized_official_credential": "LLPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Detroit, MI
• Providers in Detroit, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.