Healthcare Provider Details

I. General information

NPI: 1609222538
Provider Name (Legal Business Name): NICOLE GLOVER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 COOK RD
ORANGEBURG SC
29118-2124
US

IV. Provider business mailing address

159 TODD CREEK RD
NEESES SC
29107-9680
US

V. Phone/Fax

Practice location:
  • Phone: 503-534-2328
  • Fax: 803-531-8419
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: