Provider Demographics
NPI:1972023182
Name:GLENISE PARROTT
Entity Type:Organization
Organization Name:GLENISE PARROTT
Other - Org Name:GLENISE PARROTT LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARROTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-243-8776
Mailing Address - Street 1:1122 SAM NEWELL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1122 SAM NEWELL RD STE 106
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5016
Practice Address - Country:US
Practice Address - Phone:704-243-8776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0027851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty