Provider Demographics
NPI:1225170939
Name:GLENN, LETTICE MONTGOMERY (LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:LETTICE
Middle Name:MONTGOMERY
Last Name:GLENN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARBISON WAY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3422
Mailing Address - Country:US
Mailing Address - Phone:803-749-6620
Mailing Address - Fax:
Practice Address - Street 1:1 HARBISON WAY
Practice Address - Street 2:SUITE 229
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3422
Practice Address - Country:US
Practice Address - Phone:803-749-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC76271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical