=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477851533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUISE HALL FRUMKIN MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2011
-----------------------------------------------------
Last Update Date | 01/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 EDGEHILL RD N
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28207-1885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-446-1900
-----------------------------------------------------
Fax | 704-446-1555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 601372
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-1372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-446-1900
-----------------------------------------------------
Fax | 704-446-1555
-----------------------------------------------------
=====================================================
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 | C003456
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | C003456
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------