MEDICARE: NICOLE A. GLOVER L.P.C., L.C.A.D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	37LC00216200	NJ
2	101YP2500X	Professional Counselor	37PC00491200	NJ

General Provider Information

NPI Number	:	1053721555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE A. GLOVER L.P.C., L.C.A.D.C.

Provider Business Mailing Address
First Line	:	910 BELLEVUE AVE
Second Line	:
City	:	TRENTON
State	:	NJ
Zip	:	08618-4450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 BELLEVUE AVE
Second Line	:
City	:	TRENTON
State	:	NJ
Zip	:	08618-4450
Country	:	US
Telephone Number	:	609-672-6867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	12/18/2014

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