Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1858 | OH |
N | 103T00000X | Psychologist | 1858 | OH |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1858 | OH |
N | 103G00000X | Clinical Psychologist | 1858 | OH |
N | 103TC0700X | Clinical Psychologist | 1858 | OH |
N | 103TC1900X | Counseling Psychologist | 1858 | OH |
NPI | 1205987468 |
---|---|
Provider Name | Willie C Glover |
First Address | Columbus, OH 43220-2003 |
Second Address | Columbus, OH 43220-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 08/07/2007 |