Provider Demographics
NPI:1316579220
Name:GLAZE, LASHERA A
Entity Type:Individual
Prefix:MS
First Name:LASHERA
Middle Name:A
Last Name:GLAZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 OAKLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7223
Mailing Address - Country:US
Mailing Address - Phone:205-401-3315
Mailing Address - Fax:
Practice Address - Street 1:1515 12TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2866
Practice Address - Country:US
Practice Address - Phone:205-324-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health