Provider Demographics
NPI:1275905887
Name:BREWINGTON, TAMEKA WADE
Entity Type:Individual
Prefix:MRS
First Name:TAMEKA
Middle Name:WADE
Last Name:BREWINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 MCCLINTOCK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5114
Mailing Address - Country:US
Mailing Address - Phone:980-939-0991
Mailing Address - Fax:704-731-0980
Practice Address - Street 1:2128 MCCLINTOCK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5114
Practice Address - Country:US
Practice Address - Phone:980-939-0991
Practice Address - Fax:704-731-0980
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22814-A101YA0400X
NCA13234101YP2500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275905887Medicaid