Healthcare Provider Details

I. General information

NPI: 1023734910
Provider Name (Legal Business Name): ADRIANNA MARIE GLASGOW LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15173 NORTH RD
FENTON MI
48430-1381
US

IV. Provider business mailing address

1018 N VERLINDEN AVE
LANSING MI
48915-1458
US

V. Phone/Fax

Practice location:
  • Phone: 810-771-4074
  • Fax:
Mailing address:
  • Phone: 248-933-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: