Provider Demographics
NPI:1851642805
Name:BREWER, CORRI NICOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CORRI
Middle Name:NICOLE
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 1:604 S HERRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-2565
Mailing Address - Country:US
Mailing Address - Phone:214-850-3831
Mailing Address - Fax:
Practice Address - Street 1:604 S HERRINGTON ST
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-2565
Practice Address - Country:US
Practice Address - Phone:214-850-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-29
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66723101YP2500X
GALPC008559101YP2500X
GA508768101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)