Provider Demographics
NPI:1619561156
Name:GLENN, ERICA MCKEE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MCKEE
Last Name:GLENN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:BROOKE
Other - Last Name:MCKEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:907 BEAU RD APT 2
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-9609
Mailing Address - Country:US
Mailing Address - Phone:704-472-2739
Mailing Address - Fax:
Practice Address - Street 1:737 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1938
Practice Address - Country:US
Practice Address - Phone:828-351-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16367101YM0800X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health