Gavin Theofield, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C017506 Issued in NC

Practice address

855 Sam Newell Rd Ste 100
Matthews, NC 28105-7593

Phone

(704) 360-3637

NPI assigned

Sep 22, 2017

Last updated

Sep 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1043729965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1561 NUNNELLY LN APT 308",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297080098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 SAM NEWELL RD STE 100",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281057593",
            "telephone_number": "704-360-3637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1561 Nunnelly Ln Apt 308",
            "address_purpose": "LOCATION",
            "city": "Fort Mill",
            "state": "SC",
            "postal_code": "297080098",
            "country_code": "US",
            "telephone_number": "631-704-2820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEOFIELD",
        "first_name": "GAVIN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-22",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "LCSW-5121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C017506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Presbyterian Hospital (Novant Health Infusion Center)
• The Presbyterian Hospital (Novant Health McKee Internal Medicine)
• The Presbyterian Hospital (Novant Health Heart and Vascular Institute)
• The Secure Relationship Center, PLLC
• The Weston Group Inc
• Corrie Darcy Thomas, MS, RD, CSO, LD/N
• Dianne F Thomas
• Josie Anna Thomas, OT
• Kimberly D Thomas
• Scott Warren Thomas, M.D.

• Clinical Social Worker in Matthews, NC
• Providers in Matthews, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.