Healthcare Provider Details

I. General information

NPI: 1679818231
Provider Name (Legal Business Name): GLENDA CLARE LCMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN ST STE 113
DURHAM NC
27701-3254
US

IV. Provider business mailing address

201 W MAIN ST STE 113
DURHAM NC
27701-3254
US

V. Phone/Fax

Practice location:
  • Phone: 201-477-8376
  • Fax:
Mailing address:
  • Phone: 201-477-8376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8097
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9850
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: