Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCAS-22213 | NC |
Y | 1041C0700X | Clinical Social Worker | C010991 | NC |
N | 1041C0700X | Clinical Social Worker | P009827 | NC |
NPI | 1003292814 |
---|---|
Provider Name | Ms. Amber Medlin Glover |
First Address | Charlotte, NC 28216-0197 |
Second Address | Concord, NC 28025-3781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2015 |
Last Update Date | 05/09/2019 |