Healthcare Provider Details

I. General information

NPI: 1295460012
Provider Name (Legal Business Name): PANGKALAMA LOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 34TH STREET DR NE
HICKORY NC
28601-7703
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 828-256-9545
  • Fax: 828-256-6748
Mailing address:
  • Phone: 704-874-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP013883
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018263
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: