Provider Demographics
NPI:1356500722
Name:GLASS, MARTI J (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARTI
Middle Name:J
Last Name:GLASS
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2697 INTERNATIONAL PKWY
Mailing Address - Street 2:PARKWAY 2, STE. 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7803
Mailing Address - Country:US
Mailing Address - Phone:757-301-7129
Mailing Address - Fax:
Practice Address - Street 1:2697 INTERNATIONAL PKWY
Practice Address - Street 2:PARKWAY 2, STE. 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7803
Practice Address - Country:US
Practice Address - Phone:757-301-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004363101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor