Provider Demographics
NPI:1508092362
Name:SIMS BREWTON, MNIOKHI XAVIER (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MNIOKHI
Middle Name:XAVIER
Last Name:SIMS BREWTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 DUNLUCE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5789
Mailing Address - Country:US
Mailing Address - Phone:803-210-5344
Mailing Address - Fax:
Practice Address - Street 1:707 DUNLUCE DR APT 103
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5789
Practice Address - Country:US
Practice Address - Phone:803-210-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC170115104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker