Provider Demographics
NPI:1427136365
Name:GLENN, LOUISE S (LPC)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:S
Last Name:GLENN
Suffix:
Gender:F
Credentials:LPC
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Mailing Address - Street 1:7542 MCCRIMMON PKWY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-1879
Mailing Address - Country:US
Mailing Address - Phone:919-949-1305
Mailing Address - Fax:919-467-0065
Practice Address - Street 1:5003 SOUTHPARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9414
Practice Address - Country:US
Practice Address - Phone:919-949-1305
Practice Address - Fax:919-467-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC3505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142JGOtherBLUE CROSS BLUE SHIELD