Provider Demographics
NPI:1013072511
Name:PUMPHREY, SEAN (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:PUMPHREY
Suffix:
Gender:M
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:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1204 E FIRE TOWER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4196
Practice Address - Country:US
Practice Address - Phone:252-744-1122
Practice Address - Fax:252-744-1133
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0029851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002359Medicaid
NC11278OtherBCBS PROVIDER NUMBER
562165173OtherFED IDENTIFICATION NUMBER
562165173OtherFED IDENTIFICATION NUMBER
2877169Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NC6002359Medicaid