Provider Demographics
NPI:1013695543
Name:PLAXCO, PATRICIA ELIZABETH (LMSW, VSW-CP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:PLAXCO
Suffix:
Gender:F
Credentials:LMSW, VSW-CP
Other - Prefix:
Other - First Name:ALIIX
Other - Middle Name:
Other - Last Name:PLAXCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:124 WHITE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3026
Mailing Address - Country:US
Mailing Address - Phone:843-568-3238
Mailing Address - Fax:
Practice Address - Street 1:1435 STUART ENGALS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7311
Practice Address - Country:US
Practice Address - Phone:843-459-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15498104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker