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General NPI Number Information
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NPI Number | 1588321384
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Entity Type | Individual
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Provider Name | JAINA A GLAZE LPC
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Gender | Female
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 130 E 5TH ST
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City | SHEFFIELD
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State | AL
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Zip | 35660-2934
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Country | US
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Telephone | 256-206-1855
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Fax |
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Provider Business Mailing Address
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Address Line | 16323 GLAZE RD
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City | ATHENS
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State | AL
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Zip | 35611-7553
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Country | US
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Telephone | 256-206-1855
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4507
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License Number State | AL
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