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General NPI Number Information
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NPI Number | 1952947103
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Entity Type | Organization
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Legal Business Name | GREATER GLORY COMMUNITY CENTER
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 1015 OLD WEST INNES ST
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City | SALISBURY
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State | NC
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Zip | 28144-3171
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Country | US
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Telephone | 704-670-6299
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3215
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City | SALISBURY
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State | NC
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Zip | 28145-3215
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Country | US
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Telephone | 704-670-6299
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | FELICIA JONES
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Credential |
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Telephone | 704-670-6299
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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