Provider Demographics
NPI:1609361039
Name:GAINES-PLUNKETT, LATOYA (LISW-CP, LCSW)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:GAINES-PLUNKETT
Suffix:
Gender:F
Credentials:LISW-CP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WHISTLING KITE LN
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-6104
Mailing Address - Country:US
Mailing Address - Phone:719-229-1794
Mailing Address - Fax:
Practice Address - Street 1:610 WHISTLING KITE LN
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-6104
Practice Address - Country:US
Practice Address - Phone:719-229-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC123321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical