Healthcare Provider Details

I. General information

NPI: 1710716618
Provider Name (Legal Business Name): YVONNE LASHAWN GLENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 OFFICE SQUARE LN
VIRGINIA BEACH VA
23462-3651
US

IV. Provider business mailing address

1660 ASHTON DR
VIRGINIA BEACH VA
23464-7627
US

V. Phone/Fax

Practice location:
  • Phone: 757-563-3331
  • Fax: 948-212-3339
Mailing address:
  • Phone: 757-831-5998
  • Fax: 948-212-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701013900
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: