Provider Demographics
NPI:1376101329
Name:GLAZIER, JACOB W (PHD, MSED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:W
Last Name:GLAZIER
Suffix:
Gender:M
Credentials:PHD, MSED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 MONROE DR NE APT 3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5041
Mailing Address - Country:US
Mailing Address - Phone:309-945-5304
Mailing Address - Fax:
Practice Address - Street 1:1742 MONROE DR NE APT 3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5041
Practice Address - Country:US
Practice Address - Phone:309-945-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional