=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083134456
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNNETTE DENISE GLADNEY LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2017
-----------------------------------------------------
Last Update Date | 10/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2803 MEDICAL CAMPUS DRIVE
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27531-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-722-1883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2803 MEDICAL CAMPUS DRIVE
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27531-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-722-1883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW.09924704
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------