Provider Demographics
NPI:1760951545
Name:GLYNN, RITA HELENA (MS, CRC, LCMHCA)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:HELENA
Last Name:GLYNN
Suffix:
Gender:F
Credentials:MS, CRC, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SMITH DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1623
Mailing Address - Country:US
Mailing Address - Phone:919-698-8140
Mailing Address - Fax:
Practice Address - Street 1:404 CLUB HOUSE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-1404
Practice Address - Country:US
Practice Address - Phone:919-698-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14208101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional