Provider Demographics
NPI:1225241797
Name:GLOGAU, CHARLOTTE LOUISE (LPA)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LOUISE
Last Name:GLOGAU
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 BONAPARTE WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3618
Mailing Address - Country:US
Mailing Address - Phone:919-990-3241
Mailing Address - Fax:
Practice Address - Street 1:1106 W CORNWALLIS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5748
Practice Address - Country:US
Practice Address - Phone:919-698-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107058Medicaid