1770227712 NPI number — DR. YALANDA DEONNA GLENN DSW, LISW-CP

Table of content: DR. YALANDA DEONNA GLENN DSW, LISW-CP (NPI 1770227712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770227712 NPI number — DR. YALANDA DEONNA GLENN DSW, LISW-CP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLENN
Provider First Name:
YALANDA
Provider Middle Name:
DEONNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DSW, LISW-CP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770227712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29304-5158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-582-2411
Provider Business Mailing Address Fax Number:
864-594-0040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 THOMAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29379-2147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-582-2411
Provider Business Practice Location Address Fax Number:
864-594-0040
Provider Enumeration Date:
04/26/2022

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: 1041C0700X , with the licence number:  13490 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 17592 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13490 . This is a "SC LLR BOARD OF SOCIAL WORK EXAMINERS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 17592 . This is a "SC LLR BOARD OF SOCIAL WORK EXAMINERS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com