Provider Demographics
NPI:1275607418
Name:BREWER, HEATHER COBHAM (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:COBHAM
Last Name:BREWER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5202
Mailing Address - Country:US
Mailing Address - Phone:252-349-0853
Mailing Address - Fax:252-636-1100
Practice Address - Street 1:790 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5202
Practice Address - Country:US
Practice Address - Phone:252-349-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0050241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142KUOtherBLUE CROSS BLUE SHIELD
NC6106265Medicaid
NC142KUOtherBLUE CROSS BLUE SHIELD