Provider Demographics
NPI:1164030433
Name:BRUMMITT, SHAQUILA O'SHAY RENEE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHAQUILA
Middle Name:O'SHAY RENEE
Last Name:BRUMMITT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 UNION ST S STE 206
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1004
Mailing Address - Country:US
Mailing Address - Phone:704-918-9741
Mailing Address - Fax:704-270-6213
Practice Address - Street 1:11 UNION ST S STE 206
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1004
Practice Address - Country:US
Practice Address - Phone:704-918-9741
Practice Address - Fax:704-270-6213
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0160771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical