Provider Demographics
NPI:1447556451
Name:GLASGOW, KEENAN L (LCMHC,LCAS,CCS)
Entity Type:Individual
Prefix:MR
First Name:KEENAN
Middle Name:L
Last Name:GLASGOW
Suffix:
Gender:M
Credentials:LCMHC,LCAS,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-6664
Mailing Address - Country:US
Mailing Address - Phone:910-777-4817
Mailing Address - Fax:
Practice Address - Street 1:2018 OXFORD DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-6664
Practice Address - Country:US
Practice Address - Phone:910-777-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1758101YA0400X
NC8683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112221Medicaid