Healthcare Provider Details

I. General information

NPI: 1033036231
Provider Name (Legal Business Name): EMILY NICOLE BREWER LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ROANOKE AVE
ELIZABETH CITY NC
27909-5643
US

IV. Provider business mailing address

711 ROANOKE AVE
ELIZABETH CITY NC
27909-5643
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-4370
  • Fax: 252-337-7911
Mailing address:
  • Phone: 252-338-4370
  • Fax: 252-337-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23089
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: