Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 11415 | SC |
Y | 1041C0700X | Clinical Social Worker | C009525 | NC |
NPI | 1003214461 |
---|---|
Provider Name | Mrs. Lacresha Brumfield |
First Address | Rock Hill, SC 29732-2775 |
Second Address | Blythewood, SC 29016-8974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2014 |
Last Update Date | 07/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1831596840 | (05) | NC |
1831596840 | (05) | SC |