Provider Demographics
NPI:1164695177
Name:VICK, GLENDA GAY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:GAY
Last Name:VICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N PARSONS AVE
Mailing Address - Street 2:104A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4537
Mailing Address - Country:US
Mailing Address - Phone:813-571-1684
Mailing Address - Fax:813-657-5638
Practice Address - Street 1:407 N PARSONS AVE
Practice Address - Street 2:104A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4537
Practice Address - Country:US
Practice Address - Phone:813-571-1684
Practice Address - Fax:813-657-5638
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health