Provider Demographics
NPI:1407900079
Name:PLUMB ALLEY LCSW, INC.
Entity Type:Organization
Organization Name:PLUMB ALLEY LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GALLACHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-695-0245
Mailing Address - Street 1:27207 FUDGE RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9447
Mailing Address - Country:US
Mailing Address - Phone:276-695-0245
Mailing Address - Fax:804-412-2985
Practice Address - Street 1:27207 FUDGE RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9447
Practice Address - Country:US
Practice Address - Phone:276-695-0245
Practice Address - Fax:804-412-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040055711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ028248Medicaid
VA010217831Medicaid