Lacresha Brumfield – Clinical Social Worker

Key facts

NPI: 1003214461
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: C009525 (NC)
Practice address: 1108 Lawhorn Rd
Blythewood, SC 29016-8974
Phone: (704) 537-1022
NPI assigned: Dec 16, 2014
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
C009525	NC	MD	Clinical Social Worker

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X	C009525	NC	Yes
Clinical Social Worker	1041C0700X	11415	SC

Addresses

Primary practice location

1108 Lawhorn Rd
Blythewood, SC 29016-8974

Mailing address

1427 Valann Farm CT
Rock Hill, SC 29732-2775
Phone (803) 467-5723

Other identifiers

Identifier	Type	State	Issuer
1831596840	Medicaid	NC
1831596840	Medicaid	SC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 7, 2016.

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1003214461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1427 VALANN FARM CT",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297322775",
            "telephone_number": "803-467-5723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 LAWHORN RD",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290168974",
            "telephone_number": "704-537-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUMFIELD",
        "first_name": "LACRESHA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-16",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C009525",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "11415",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831596840",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831596840",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blythewood, SC

All providers in Blythewood, SC · Clinical Social Worker in South Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.