Gavin Theofield, LCSW
Individual provider Active NPI Clinical Social Worker · Matthews, NC
NPI 1043729965 · NPPES record last updated Sep 17, 2024
Key facts
- NPI
- 1043729965
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- C017506 (NC)
- Practice address
- 855 Sam Newell Rd Ste 100
Matthews, NC 28105-7593 - Phone
- (704) 360-3637
- NPI assigned
- Sep 22, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241202002034 | NC | Practitioner - Clinical Social Worker | 1951836832 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-5121 | HI | MD | Clinical Social Worker |
| C017506 | NC | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-5121 | HI | |
| Clinical Social Worker | 1041C0700X | C017506 | NC | Yes |
Addresses
Primary practice location
855 Sam Newell Rd Ste 100
Matthews, NC 28105-7593
Mailing address
1561 Nunnelly LN Apt 308
Fort Mill, SC 29708-0098
Other practice location 1
1561 Nunnelly Ln Apt 308
Fort Mill, SC 29708-0098
Phone (631) 704-2820
Other providers in Matthews, NC
- The Presbyterian Hospital
- The Presbyterian Hospital
- The Secure Relationship Center, PLLC
- The Weston Group Inc
- Ashish Dinesh Thekdi
- Corrie Darcy Thomas
- Dianne F Thomas
- Josie Anna Thomas
- Kimberly D Thomas
- Scott Warren Thomas
All providers in Matthews, NC · Clinical Social Worker in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.