Healthcare Provider Details

I. General information

NPI: 1093234049
Provider Name (Legal Business Name): LUANNE BRIGMAN IMHOLT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 WINDSOR RUN LN
MATTHEWS NC
28105-0054
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 704-443-6250
  • Fax: 704-443-6279
Mailing address:
  • Phone: 704-443-6250
  • Fax: 704-443-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2116
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: