1619561156 NPI number — ERICA MCKEE GLENN LCMHCA

Table of content: ERICA MCKEE GLENN LCMHCA (NPI 1619561156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619561156 NPI number — ERICA MCKEE GLENN LCMHCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLENN
Provider First Name:
ERICA
Provider Middle Name:
MCKEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCKEE
Provider Other First Name:
ERICA
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCMHCA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619561156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 BEAU RD APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28152-9609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-472-2739
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
737 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPINDALE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28160-1938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-351-4126
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  A16367 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: A16367 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)