Healthcare Provider Details

I. General information

NPI: 1548756406
Provider Name (Legal Business Name): DENIQUAH IMANI GLOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 BOULEVARD
COLONIAL HEIGHTS VA
23834-2325
US

IV. Provider business mailing address

4107 MALLARD LANDING CIR APT 101
MIDLOTHIAN VA
23112-3384
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-2395
  • Fax: 804-526-2396
Mailing address:
  • Phone: 948-230-6926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0730000813
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: