=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457503179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW SCOTT BRIMHALL PH.D., LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2008
-----------------------------------------------------
Last Update Date | 01/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 E ARLINGTON BLVD STE 9A
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-5050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-964-1352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 E ARLINGTON BLVD STE 9A
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-5050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-964-1352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | NCLMFT1543
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------