Provider Demographics
NPI:1457804148
Name:BRUMFIELD, ERICA ASHLEY (LPC)
Entity type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:ASHLEY
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:601-874-3340
Mailing Address - Fax:601-494-3340
Practice Address - Street 1:501 AVALON WAY STE D
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7500
Practice Address - Country:US
Practice Address - Phone:601-874-3340
Practice Address - Fax:601-494-3241
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1843101Y00000X, 101YP2500X
LA9780101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS009356703Medicaid