Provider Demographics
NPI:1619281656
Name:CARR, GLORIA FAYE (BA)
Entity Type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:FAYE
Last Name:CARR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 WESLEY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4121
Mailing Address - Country:US
Mailing Address - Phone:903-455-9090
Mailing Address - Fax:903-455-9092
Practice Address - Street 1:2718 WESLEY ST
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4121
Practice Address - Country:US
Practice Address - Phone:903-455-9090
Practice Address - Fax:903-455-9092
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor