Provider Demographics
NPI:1467739631
Name:BRUMMELL, SHIRIKA MONIQUE (LCAS-P)
Entity Type:Individual
Prefix:
First Name:SHIRIKA
Middle Name:MONIQUE
Last Name:BRUMMELL
Suffix:
Gender:F
Credentials:LCAS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 EASTBROOK DR
Mailing Address - Street 2:APT G
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4230
Mailing Address - Country:US
Mailing Address - Phone:252-916-4419
Mailing Address - Fax:
Practice Address - Street 1:307 EASTBROOK DR
Practice Address - Street 2:APT G
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4230
Practice Address - Country:US
Practice Address - Phone:252-916-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health