Healthcare Provider Details

I. General information

NPI: 1952106361
Provider Name (Legal Business Name): GLEE CLUB COUNSELING AND CONSULTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 MCCULLOUGH DR STE 205
CHARLOTTE NC
28262-4392
US

IV. Provider business mailing address

1815 BOWERY CT
CHARLOTTE NC
28215-4199
US

V. Phone/Fax

Practice location:
  • Phone: 704-430-7686
  • Fax:
Mailing address:
  • Phone: 704-430-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. GLORIA RIOS
Title or Position: VOCATIONAL REHABILITATION THERAPIST
Credential: LCMHC, CRC
Phone: 704-430-7686