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General NPI Number Information
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NPI Number | 1891819777
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Entity Type | Individual
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Provider Name | GWEN A GLATTHORN LCAS,LCMHC
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Gender | Female
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Dates
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Enumeration Date | 03/18/2007
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 211 E SIX FORKS RD STE 117
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City | RALEIGH
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State | NC
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Zip | 27609-7753
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Country | US
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Telephone | 215-970-3373
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 LONG MEADOW CT APT 202
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City | RALEIGH
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State | NC
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Zip | 27613-3215
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Country | US
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Telephone | 215-970-3373
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1055
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4993
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License Number State | NC
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