Provider Demographics
NPI:1588137574
Name:GLICKMAN, COURTNEY (MA, LPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 TYDINGS RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5729
Mailing Address - Country:US
Mailing Address - Phone:727-324-3606
Mailing Address - Fax:
Practice Address - Street 1:8626 LEE HWY STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2135
Practice Address - Country:US
Practice Address - Phone:703-560-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health