Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 386 | NC |
N | 101YP1600X | Pastoral Counselor | 386 | NC |
Y | 101YP2500X | Professional Counselor | 386 | NC |
NPI | 1114122389 |
---|---|
Provider Name | Keith Glover |
First Address | Raleigh, NC 27609-4109 |
Second Address | Wake Forest, NC 27587-4527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 05/10/2007 |