Provider Demographics
NPI:1083122667
Name:GLOCK, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GLOCK
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 1:7524 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7594
Mailing Address - Country:US
Mailing Address - Phone:410-746-5868
Mailing Address - Fax:
Practice Address - Street 1:7524 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7594
Practice Address - Country:US
Practice Address - Phone:410-746-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional