Provider Demographics
NPI:1417519489
Name:GLAWSON, LIZ MARIE (CADCII)
Entity Type:Individual
Prefix:MS
First Name:LIZ
Middle Name:MARIE
Last Name:GLAWSON
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:MS
Other - First Name:LIZ
Other - Middle Name:GLAWSON
Other - Last Name:FIEBIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADCII
Mailing Address - Street 1:607 RUSSELL PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7690
Mailing Address - Country:US
Mailing Address - Phone:478-225-9860
Mailing Address - Fax:
Practice Address - Street 1:607 RUSSELL PKWY STE A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7690
Practice Address - Country:US
Practice Address - Phone:478-225-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA764101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)