Provider Demographics
NPI:1215428537
Name:GLISSON, ANNA DOLLY
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:DOLLY
Last Name:GLISSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 COLLINS PORT CV
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2788
Mailing Address - Country:US
Mailing Address - Phone:770-570-2731
Mailing Address - Fax:678-682-8219
Practice Address - Street 1:3455 LAWRENCEVILLE SUWANEE RD STE A
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6425
Practice Address - Country:US
Practice Address - Phone:770-932-2899
Practice Address - Fax:770-932-2895
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health