Provider Demographics
NPI:1104941319
Name:BREWER, TERRANCE DELORES (LMSW)
Entity type:Individual
Prefix:MS
First Name:TERRANCE
Middle Name:DELORES
Last Name:BREWER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 SENATOR ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-2847
Mailing Address - Country:US
Mailing Address - Phone:870-216-1700
Mailing Address - Fax:870-772-5965
Practice Address - Street 1:4425 JEFFERSON AVE STE 106
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1529
Practice Address - Country:US
Practice Address - Phone:870-216-1700
Practice Address - Fax:870-772-5965
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1875-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker