Provider Demographics
NPI:1396198461
Name:GLENN, CHRIS (PHD, NCACI)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:GLENN
Suffix:
Gender:M
Credentials:PHD, NCACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W FAIRMONT AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3455
Mailing Address - Country:US
Mailing Address - Phone:912-601-7163
Mailing Address - Fax:
Practice Address - Street 1:37 W FAIRMONT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3455
Practice Address - Country:US
Practice Address - Phone:912-601-7163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3384101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)