=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518862929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUSTIN ALFREDO TRUJILLO LCSWA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2026
-----------------------------------------------------
Last Update Date | 10/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2353 CONCORD LAKE RD STE 160
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-2892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-781-5156
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 2ND AVE
-----------------------------------------------------
City | CHINA GROVE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28023-2395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-439-5161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P024133
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------