Provider Demographics
NPI:1164581203
Name:GLASGOW, LINDA C (CEO)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:C
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 EMERYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-3765
Mailing Address - Country:US
Mailing Address - Phone:336-297-5025
Mailing Address - Fax:
Practice Address - Street 1:2206 EMERYWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-3765
Practice Address - Country:US
Practice Address - Phone:336-297-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-795323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility