Healthcare Provider Details

I. General information

NPI: 1760142335
Provider Name (Legal Business Name): ELIZABETH SPARKS BREWER M.ED., ALC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 INTERSTATE PARK DR STE 603
MONTGOMERY AL
36109-5423
US

IV. Provider business mailing address

PO BOX 11087
MONTGOMERY AL
36111-0087
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-1304
  • Fax: 334-356-1426
Mailing address:
  • Phone: 334-481-1599
  • Fax: 334-356-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC3988A
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1461554
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: