Provider Demographics
NPI:1912217530
Name:DENISE GLANVILLE, LLC
Entity Type:Organization
Organization Name:DENISE GLANVILLE, LLC
Other - Org Name:WELLSPRING POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-966-7505
Mailing Address - Street 1:3316 S COBB DR SE STE A
Mailing Address - Street 2:SUITE 324
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4107
Mailing Address - Country:US
Mailing Address - Phone:404-966-7505
Mailing Address - Fax:
Practice Address - Street 1:315 W PONCE DE LEON AVE
Practice Address - Street 2:SUITE 1051
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2400
Practice Address - Country:US
Practice Address - Phone:404-378-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-16
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003074103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty