Provider Demographics
NPI:1184178428
Name:CONDON, GLYNDORA SPRING (MS, LPC, CTMH, CCTP,)
Entity type:Individual
Prefix:
First Name:GLYNDORA
Middle Name:SPRING
Last Name:CONDON
Suffix:
Gender:F
Credentials:MS, LPC, CTMH, CCTP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 LAKEWOOD CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-8243
Mailing Address - Country:US
Mailing Address - Phone:423-790-4906
Mailing Address - Fax:423-790-7074
Practice Address - Street 1:1510 STUART RD NE STE 101
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5869
Practice Address - Country:US
Practice Address - Phone:423-790-4906
Practice Address - Fax:423-790-7074
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC3583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional