Provider Demographics
NPI:1023980380
Name:BROWER, DERRICK
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:BROWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 COX PL APT 2F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-3446
Mailing Address - Country:US
Mailing Address - Phone:336-303-5509
Mailing Address - Fax:
Practice Address - Street 1:4100 COX PL APT 2F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-3446
Practice Address - Country:US
Practice Address - Phone:336-303-5509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health