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General NPI Number Information
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NPI Number | 1366575045
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Entity Type | Individual
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Provider Name | DONALD JAMES GLOEGE LCSW, LISW-CP, BCD
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 825 E KING ST
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-3186
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Country | US
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Telephone | 980-487-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 112 WICHITA DR
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City | SHELBY
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State | NC
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Zip | 28152-7763
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Country | US
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Telephone | 704-434-8952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8663
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C004703
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License Number State | NC
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