Provider Demographics
NPI:1558112763
Name:GLOVER, PENNY (RBT)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 HILLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-3129
Mailing Address - Country:US
Mailing Address - Phone:919-691-2859
Mailing Address - Fax:
Practice Address - Street 1:314 CHAPANOKE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3400
Practice Address - Country:US
Practice Address - Phone:919-773-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician