Provider Demographics
NPI:1437333937
Name:GLENN, CA TRICE B (LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:CA TRICE
Middle Name:B
Last Name:GLENN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 119-109
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5860
Mailing Address - Country:US
Mailing Address - Phone:770-464-5123
Mailing Address - Fax:
Practice Address - Street 1:145 AUTRY ST
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1919
Practice Address - Country:US
Practice Address - Phone:770-464-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 101YS0200X
GAAPC001682101YP2500X
GALPC006136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool