Provider Demographics
NPI:1225258718
Name:GLENNA, DEBORAH JEAN (LPC, CPCS, MAC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN
Last Name:GLENNA
Suffix:
Gender:F
Credentials:LPC, CPCS, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 PARKWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1326
Mailing Address - Country:US
Mailing Address - Phone:678-487-6641
Mailing Address - Fax:770-999-9459
Practice Address - Street 1:542 PARKWOOD WAY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1326
Practice Address - Country:US
Practice Address - Phone:770-460-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008554101YM0800X
GA1646-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC008554Other582098758