Provider Demographics
NPI:1609085919
Name:GLASS, JONATHAN MICHAEL (LCMHC, NCC, CAP)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:GLASS
Suffix:
Gender:M
Credentials:LCMHC, NCC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14847 AMERINA WAY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-5701
Mailing Address - Country:US
Mailing Address - Phone:843-503-9034
Mailing Address - Fax:
Practice Address - Street 1:1293 HENDERSONVILLE RD STE 19
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1956
Practice Address - Country:US
Practice Address - Phone:828-785-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL214764101Y00000X
FL2421L101YA0400X
FLMH6116101YM0800X
SC4814101YP2500X
NC17135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health