Provider Demographics
NPI:1710366554
Name:PLUMMER, CAROL A (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:OOKALA
Mailing Address - State:HI
Mailing Address - Zip Code:96774-0032
Mailing Address - Country:US
Mailing Address - Phone:225-803-7702
Mailing Address - Fax:
Practice Address - Street 1:305 WAILUKU DR
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2488
Practice Address - Country:US
Practice Address - Phone:225-803-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI38891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical