Basic Information
| Provider Information | |||||||||
| NPI: | 1851971907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COCAGNE | ||||||||
| FirstName: | BREANNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2325 LAKESHORE BLVD APT 626 | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481986914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349997774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 GOLFSIDE DR STE 3 | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481081410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348210216 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2021 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 6851115357 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.