Provider Demographics
NPI:1750660197
Name:EVERSOLE, GLENDA SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:SUE
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2467
Mailing Address - Country:US
Mailing Address - Phone:501-743-9470
Mailing Address - Fax:501-843-1217
Practice Address - Street 1:217 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2944
Practice Address - Country:US
Practice Address - Phone:501-743-9470
Practice Address - Fax:501-843-1217
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker