Provider Demographics
NPI:1396706990
Name:MYERS, RICHARD GLENN JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GLENN
Last Name:MYERS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-6180
Mailing Address - Country:US
Mailing Address - Phone:704-547-0020
Mailing Address - Fax:
Practice Address - Street 1:801 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-6180
Practice Address - Country:US
Practice Address - Phone:704-547-0020
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical