Healthcare Provider Details

I. General information

NPI: 1083099360
Provider Name (Legal Business Name): AARON PLANTENBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 MEDICAL PARK LOOP
SYLVA NC
28779-5271
US

IV. Provider business mailing address

PO BOX 2187
SYLVA NC
28779-2187
US

V. Phone/Fax

Practice location:
  • Phone: 828-631-3973
  • Fax: 828-631-9280
Mailing address:
  • Phone: 828-631-3973
  • Fax: 828-631-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010916
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21675
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP009574
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: