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General NPI Number Information
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NPI Number | 1093855892
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Entity Type | Organization
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Legal Business Name | GLASS AND HENRY PC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 505 S INDEPENDENCE BLVD SUITE 207
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1150
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Country | US
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Telephone | 757-497-4965
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Fax | 757-497-4197
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Provider Business Mailing Address
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Address Line | 505 S INDEPENDENCE BLVD SUITE 207
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1150
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Country | US
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Telephone | 757-497-4965
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Fax | 757-497-4197
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Authorized Official
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Title or Position | OWNER
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Name | MARY ANN BAILEY HENRY
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Credential | LCSW
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Telephone | 757-497-4965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904003282
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License Number State | VA
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