1669886925 NPI number — MRS. REBECCA EVE GLAVIN MBA, MSW, LCSW-A

Table of content: MRS. REBECCA EVE GLAVIN MBA, MSW, LCSW-A (NPI 1669886925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669886925 NPI number — MRS. REBECCA EVE GLAVIN MBA, MSW, LCSW-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLAVIN
Provider First Name:
REBECCA
Provider Middle Name:
EVE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MBA, MSW, LCSW-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATERS
Provider Other First Name:
REBECCA
Provider Other Middle Name:
EVE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669886925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4724 PARK RD
Provider Second Line Business Mailing Address:
SUITE A1
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28209-2265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-231-1902
Provider Business Mailing Address Fax Number:
253-595-7574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4724 PARK RD
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-231-1902
Provider Business Practice Location Address Fax Number:
253-595-7574
Provider Enumeration Date:
06/16/2014

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:  MHL-060-1274 , 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)





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