Provider Demographics
NPI:1528237864
Name:GALLOWAY, GLENDA STEVENS
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:STEVENS
Last Name:GALLOWAY
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 1:1020 ZION HILL RD
Mailing Address - Street 2:VIRGINIA WILLIAMSON ELEMENTARY SCHOOL
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422
Mailing Address - Country:US
Mailing Address - Phone:910-754-8660
Mailing Address - Fax:910-754-8661
Practice Address - Street 1:1606 HARBOUR DRIVE
Practice Address - Street 2:BERTRAND CARANAUGH & ASSOCIATES
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-792-9441
Practice Address - Fax:910-792-9574
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5304101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health