Provider Demographics
NPI:1508441486
Name:GLASS, LARHONDA K (LSW)
Entity Type:Individual
Prefix:MISS
First Name:LARHONDA
Middle Name:K
Last Name:GLASS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 TRACELAND DR STE B
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4226
Mailing Address - Country:US
Mailing Address - Phone:662-680-9191
Mailing Address - Fax:662-680-9196
Practice Address - Street 1:2610 TRACELAND DR STE B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4226
Practice Address - Country:US
Practice Address - Phone:662-680-9191
Practice Address - Fax:662-680-9196
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW9205104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker