Provider Demographics
NPI:1558340166
Name:RUMBAUGH, PAUL C JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:C
Last Name:RUMBAUGH
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:C
Other - Last Name:RUMBAUGH
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1310 WORSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5451
Mailing Address - Country:US
Mailing Address - Phone:910-868-9767
Mailing Address - Fax:
Practice Address - Street 1:1617 OWEN DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3425
Practice Address - Country:US
Practice Address - Phone:910-484-3330
Practice Address - Fax:910-484-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130KJOtherBLUE CROSS BLUE SHIELD
NC6002297Medicaid