Healthcare Provider Details

I. General information

NPI: 1023412822
Provider Name (Legal Business Name): REBECCA BROOKS PREWITT EDS, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 B FAIRMONT STREET
CLINTON MS
39056
US

IV. Provider business mailing address

700 BERKSHIRE STREET
CLINTON MS
39056
US

V. Phone/Fax

Practice location:
  • Phone: 601-351-9877
  • Fax:
Mailing address:
  • Phone: 601-594-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC5043
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: