Provider Demographics
NPI:1750737698
Name:BREWTON, KRISTIN PAGE (LAC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:PAGE
Last Name:BREWTON
Suffix:
Gender:F
Credentials:LAC
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 2453
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-2453
Mailing Address - Country:US
Mailing Address - Phone:318-214-4002
Mailing Address - Fax:318-214-4004
Practice Address - Street 1:830 4TH ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4569
Practice Address - Country:US
Practice Address - Phone:318-214-4002
Practice Address - Fax:318-214-4004
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1561101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)