Provider Demographics
NPI:1457804148
Name:BRUMFIELD, ERICA (LPC)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:LPC
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 68375
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39286-8375
Mailing Address - Country:US
Mailing Address - Phone:601-715-5541
Mailing Address - Fax:
Practice Address - Street 1:3900 LAKELAND DR STE 504
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8854
Practice Address - Country:US
Practice Address - Phone:225-772-2137
Practice Address - Fax:601-494-3241
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018213Medicaid