Provider Demographics
NPI:1861134553
Name:PLUNKETT, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-3271
Mailing Address - Country:US
Mailing Address - Phone:850-346-6256
Mailing Address - Fax:
Practice Address - Street 1:17 S DE VILLIERS ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5511
Practice Address - Country:US
Practice Address - Phone:850-266-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical