Basic Information
| Provider Information | |||||||||
| NPI: | 1477851533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRUMKIN | ||||||||
| FirstName: | LOUISE | ||||||||
| MiddleName: | HALL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601372 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044461900 | ||||||||
| FaxNumber: | 7044461555 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 EDGEHILL RD N | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044461900 | ||||||||
| FaxNumber: | 7044461555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2011 | ||||||||
| LastUpdateDate: | 01/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C003456 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | C003456 | NC | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 6007884 | 05 | NC | MEDICAID | 1477851533 | 05 | NC | MEDICAID |