MEDICARE: PAULETTE PLUMMER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C005644	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457559858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULETTE PLUMMER LCSW

Provider Business Mailing Address
First Line	:	6706 SEQUOIA HILLS DR
Second Line	:
City	:	HARRISBURG
State	:	NC
Zip	:	27075
Country	:	US
Telephone Number	:	704-707-3896
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 NORTH TRYON ST.
Second Line	:	SUITE 339
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2773
Country	:	US
Telephone Number	:	704-405-5993
Fax Number	:	704-405-5994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	08/28/2007

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