Provider Demographics
NPI:1346541133
Name:REESE, GLEN (LMSW)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CREST LANE DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8600
Mailing Address - Country:US
Mailing Address - Phone:404-461-7961
Mailing Address - Fax:678-402-5332
Practice Address - Street 1:103 CREST LANE DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8600
Practice Address - Country:US
Practice Address - Phone:404-461-7961
Practice Address - Fax:678-402-5332
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0051721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical