Provider Demographics
NPI:1609390319
Name:GLENN, SUBRENA ANN
Entity Type:Individual
Prefix:DR
First Name:SUBRENA
Middle Name:ANN
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 BROOKSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5714
Mailing Address - Country:US
Mailing Address - Phone:770-912-7088
Mailing Address - Fax:
Practice Address - Street 1:3745 BROOKSIDE PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5714
Practice Address - Country:US
Practice Address - Phone:770-912-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor