Provider Demographics
NPI:1588359707
Name:GLOSSON, KIA GRANTHAM
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:GRANTHAM
Last Name:GLOSSON
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 1:710 CROMWELL DR STE D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5441
Mailing Address - Country:US
Mailing Address - Phone:252-565-6275
Mailing Address - Fax:252-203-5052
Practice Address - Street 1:710 CROMWELL DR STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5441
Practice Address - Country:US
Practice Address - Phone:252-565-6275
Practice Address - Fax:252-203-5052
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NCP0181001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical