Healthcare Provider Details

I. General information

NPI: 1164912291
Provider Name (Legal Business Name): JUSTIN A PLUMMER LPC CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5829 PROSPECT LN
WESTERVILLE OH
43082-7107
US

IV. Provider business mailing address

5829 PROSPECT LN
WESTERVILLE OH
43082-7107
US

V. Phone/Fax

Practice location:
  • Phone: 614-568-8322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2606192
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: