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NPI Code Detail

MEDICARE: MR. ROGER GLOSSON EDWARDS LPC

MEDICARE:  MR. ROGER GLOSSON EDWARDS  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
1101Y00000XCounselor857NC

General Provider Information

NPI Number : 1760640858
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROGER GLOSSON EDWARDS LPC
Provider Business Mailing Address
First Line : 413 S SHARON AMITY RD STE B
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-2881
Country : US
Telephone Number : 704-365-4545
Fax Number : 704-365-4412
Provider Business Practice Location Address
First Line : 413 S SHARON AMITY RD STE B
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-2881
Country : US
Telephone Number : 704-365-4545
Fax Number : 704-365-4412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2008
Last Update Date : 05/27/2008

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Directions to “ MR. ROGER GLOSSON EDWARDS LPC” Practice Location

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