Provider Demographics
NPI:1225515646
Name:HARCUS, GLORIA NADINE (BS, LCDC III)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:NADINE
Last Name:HARCUS
Suffix:
Gender:F
Credentials:BS, LCDC III
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:NADINE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3103 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1653
Mailing Address - Country:US
Mailing Address - Phone:513-892-4673
Mailing Address - Fax:513-737-1107
Practice Address - Street 1:302 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-5037
Practice Address - Country:US
Practice Address - Phone:937-281-4673
Practice Address - Fax:937-318-1120
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.162320101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)