MEDICARE: MR. THEODORE THOMASON PLUMMER II

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	101YM0800X	Mental Health Counselor	11677772	VA

General Provider Information

NPI Number	:	1831056142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE THOMASON PLUMMER II

Provider Business Mailing Address
First Line	:	4904 FRISHMAN CT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3238
Country	:	US
Telephone Number	:	571-462-8632
Fax Number	:

Provider Business Practice Location Address
First Line	:	4904 FRISHMAN CT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3238
Country	:	US
Telephone Number	:	571-462-8632
Fax Number	:

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/08/2026

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