Provider Demographics
NPI:1356452866
Name:LOVETT, GLORIA DURHAM (MSW)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:DURHAM
Last Name:LOVETT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 ABINGTON LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5813
Mailing Address - Country:US
Mailing Address - Phone:919-231-7295
Mailing Address - Fax:919-250-1176
Practice Address - Street 1:3009 ABINGTON LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-5813
Practice Address - Country:US
Practice Address - Phone:919-231-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0012201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235118BOtherMEDICARE PTAN
NC6003638Medicaid