Healthcare Provider Details

I. General information

NPI: 1679436000
Provider Name (Legal Business Name): CHAREESE BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 E JEFFERSON AVE STE 400
DETROIT MI
48207-4105
US

IV. Provider business mailing address

14234 CHERRYLAWN ST
DETROIT MI
48238-2458
US

V. Phone/Fax

Practice location:
  • Phone: 313-351-3811
  • Fax:
Mailing address:
  • Phone: 313-351-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: