Basic Information
| Provider Information | |||||||||
| NPI: | 1700011020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN-FAGAN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | EVETTE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 S SAGINAW ST | ||||||||
| Address2: | 302 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485021841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108143535 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 901 CHIPPEWA ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485031552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102329950 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2009 | ||||||||
| LastUpdateDate: | 05/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401011313 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.