Provider Demographics
NPI:1760866610
Name:MARGARET ROSE GLENN COUNSELING, PLLC
Entity Type:Organization
Organization Name:MARGARET ROSE GLENN COUNSELING, PLLC
Other - Org Name:MARGARET ROSE GLENN COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:904-236-0507
Mailing Address - Street 1:4375 US HIGHWAY 17
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4832
Mailing Address - Country:US
Mailing Address - Phone:904-236-0507
Mailing Address - Fax:
Practice Address - Street 1:4375 US HIGHWAY 17
Practice Address - Street 2:SUITE 103
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4832
Practice Address - Country:US
Practice Address - Phone:904-236-0507
Practice Address - Fax:904-269-0499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARGARET ROSE GLENN COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-09
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW36661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053727826OtherNPPES
1053727826OtherNPPES