Provider Demographics
NPI:1184042657
Name:GUM, NOLA GLENORA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:NOLA
Middle Name:GLENORA
Last Name:GUM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2931
Mailing Address - Country:US
Mailing Address - Phone:304-431-2424
Mailing Address - Fax:304-431-3443
Practice Address - Street 1:205 CENTER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2931
Practice Address - Country:US
Practice Address - Phone:304-431-2424
Practice Address - Fax:304-431-3443
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP00943432101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023441001Medicaid
WV0005489001Medicaid