Healthcare Provider Details

I. General information

NPI: 1982724613
Provider Name (Legal Business Name): GLB HEALTH AND ASSESSMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 W US HIGHWAY 74
ROCKINGHAM NC
28379-3397
US

IV. Provider business mailing address

PO BOX 472
ROCKINGHAM NC
28380-0472
US

V. Phone/Fax

Practice location:
  • Phone: 910-997-2620
  • Fax: 910-997-2622
Mailing address:
  • Phone: 910-997-2620
  • Fax: 910-997-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY LOCKLEAR BULLARD
Title or Position: OWNER
Credential:
Phone: 910-997-2620