Provider Demographics
NPI:1346696143
Name:CAROLYN KATES-GLASS, MSW, LCSW
Entity Type:Organization
Organization Name:CAROLYN KATES-GLASS, MSW, LCSW
Other - Org Name:DESTINY ADULT, CHILD AND FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATES-GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:270-392-5531
Mailing Address - Street 1:1338 WESTEN ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3365
Mailing Address - Country:US
Mailing Address - Phone:270-392-5531
Mailing Address - Fax:270-843-0607
Practice Address - Street 1:1338 WESTEN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3365
Practice Address - Country:US
Practice Address - Phone:270-392-5531
Practice Address - Fax:270-843-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty