Provider Demographics
NPI:1205995990
Name:BREWSTER, JAMES DOUGLAS (LPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:BREWSTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MEADOW RUN RD
Mailing Address - Street 2:
Mailing Address - City:MINNORA
Mailing Address - State:WV
Mailing Address - Zip Code:25268-1212
Mailing Address - Country:US
Mailing Address - Phone:304-655-8959
Mailing Address - Fax:
Practice Address - Street 1:ASACS
Practice Address - Street 2:BASSETT ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-0469
Practice Address - Country:US
Practice Address - Phone:907-353-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001956101YM0800X
PAPC003016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health