Provider Demographics
NPI:1760142335
Name:SPARKS BREWER, ELIZABETH (MED, ALC, NCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SPARKS BREWER
Suffix:
Gender:F
Credentials:MED, ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11087
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-0087
Mailing Address - Country:US
Mailing Address - Phone:334-481-1599
Mailing Address - Fax:334-356-1426
Practice Address - Street 1:600 INTERSTATE PARK DR STE 603
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-5423
Practice Address - Country:US
Practice Address - Phone:334-356-1304
Practice Address - Fax:334-356-1426
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3988A101Y00000X
1461554101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor