Provider Demographics
NPI:1104147818
Name:HARRISON, GLENDOLYN (LISW-CP)
Entity type:Individual
Prefix:
First Name:GLENDOLYN
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125E WAPPOO CREEK DRIVE
Mailing Address - Street 2:SUITE 101E
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-718-0730
Mailing Address - Fax:
Practice Address - Street 1:125E WAPPOO CREEK DRIVE
Practice Address - Street 2:SUITE 101E
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-718-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC48711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical