Provider Demographics
NPI:1992496715
Name:PLUMB, MARC (RADT-1)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:PLUMB
Suffix:
Gender:M
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 PLEASANT VALLEY RD.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619
Mailing Address - Country:US
Mailing Address - Phone:530-344-7633
Mailing Address - Fax:
Practice Address - Street 1:484 PLEASANT VALLEY RD. #4
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9561
Practice Address - Country:US
Practice Address - Phone:530-344-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1481240922101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)