Provider Demographics
NPI:1275657132
Name:VINSON-NNAJI, GLENDA LENA (LCMHCS, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:LENA
Last Name:VINSON-NNAJI
Suffix:
Gender:F
Credentials:LCMHCS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 MATTHEWS MINT HILL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2895
Mailing Address - Country:US
Mailing Address - Phone:704-619-3490
Mailing Address - Fax:704-849-5251
Practice Address - Street 1:317 MATTHEWS MINT HILL RD STE 207
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2895
Practice Address - Country:US
Practice Address - Phone:704-619-3490
Practice Address - Fax:704-849-5251
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-2934101YA0400X
NCS5220101YM0800X
NC6103193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103193Medicaid