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NPI Code Detail

MEDICARE: GLENDA L CORDY LPC

MEDICARE:   GLENDA L CORDY  LPC
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
1101YP2500XProfessional CounselorLPC0004313GA

General Provider Information

NPI Number : 1104913409
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENDA L CORDY LPC
Provider Business Mailing Address
First Line : PO BOX 2153
Second Line :
City : LITHONIA
State : GA
Zip : 30058-1046
Country : US
Telephone Number : 770-385-6280
Fax Number :
Provider Business Practice Location Address
First Line : 2143 WASHINGTON ST SW
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2361
Country : US
Telephone Number : 770-385-6280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 07/08/2007

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Directions to “ GLENDA L CORDY LPC” Practice Location

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