Provider Demographics
NPI:1992101588
Name:GLASS, YOLANDA (LICSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7851 EAGLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-4645
Mailing Address - Country:US
Mailing Address - Phone:301-254-1603
Mailing Address - Fax:
Practice Address - Street 1:2400 W 64TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-1001
Practice Address - Country:US
Practice Address - Phone:612-331-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500800951041C0700X
MN324201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical