Provider Demographics
NPI:1285744193
Name:THOMAS M. PLOTT AND BARBARA R. BALLARD
Entity type:Organization
Organization Name:THOMAS M. PLOTT AND BARBARA R. BALLARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-358-4641
Mailing Address - Street 1:2309 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1525
Mailing Address - Country:US
Mailing Address - Phone:704-358-4641
Mailing Address - Fax:704-358-4642
Practice Address - Street 1:2309 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1525
Practice Address - Country:US
Practice Address - Phone:704-358-4641
Practice Address - Fax:704-358-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014A4OtherBCBS NUMBER