Provider Demographics
NPI:1588379028
Name:PREWITT, BRIANNA MICHELLE (MA, LPCA)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MICHELLE
Last Name:PREWITT
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 PROSPEROUS PL STE 2B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1862
Mailing Address - Country:US
Mailing Address - Phone:859-707-3025
Mailing Address - Fax:
Practice Address - Street 1:155 PROSPEROUS PL STE 2B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1862
Practice Address - Country:US
Practice Address - Phone:502-438-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8322502Medicaid