Provider Demographics
NPI:1649638461
Name:BREVARD, DEVITA DENESE (LCSW-C)
Entity type:Individual
Prefix:
First Name:DEVITA
Middle Name:DENESE
Last Name:BREVARD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N CHARLES ST
Mailing Address - Street 2:STE 204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5920
Mailing Address - Country:US
Mailing Address - Phone:443-386-7537
Mailing Address - Fax:
Practice Address - Street 1:1800 N CHARLES ST
Practice Address - Street 2:STE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5920
Practice Address - Country:US
Practice Address - Phone:443-386-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health