Provider Demographics
NPI:1720548373
Name:BREWER, RHONDA (LPC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 PURVIS OLOH RD
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-4258
Mailing Address - Country:US
Mailing Address - Phone:601-550-1081
Mailing Address - Fax:
Practice Address - Street 1:1237 PURVIS OLOH RD
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-4258
Practice Address - Country:US
Practice Address - Phone:601-550-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional