Provider Demographics
NPI:1003214461
Name:BRUMFIELD, LACRESHA
Entity Type:Individual
Prefix:MRS
First Name:LACRESHA
Middle Name:
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 VALANN FARM CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2775
Mailing Address - Country:US
Mailing Address - Phone:803-467-5723
Mailing Address - Fax:
Practice Address - Street 1:1108 LAWHORN RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8974
Practice Address - Country:US
Practice Address - Phone:704-537-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0095251041C0700X
SC114151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831596840Medicaid
SC1831596840Medicaid