MEDICARE: MR. GLENN N SCARBORO LCSW

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	101YM0800X	Mental Health Counselor	0904001696	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669578027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GLENN N SCARBORO LCSW

Provider Business Mailing Address
First Line	:	1045 MAIN STREET, SUITE 5
Second Line	:	COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
City	:	DANVILLE
State	:	VA
Zip	:	24541-1800
Country	:	US
Telephone Number	:	434-792-2277
Fax Number	:	434-792-2279

Provider Business Practice Location Address
First Line	:	500 PINEY FOREST RD
Second Line	:	SUITE C
City	:	DANVILLE
State	:	VA
Zip	:	24540-3315
Country	:	US
Telephone Number	:	434-792-7437
Fax Number	:	434-792-7434

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	06/25/2014

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