Provider Demographics
NPI:1245288828
Name:DILLARD, AMBER GLASCO (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:GLASCO
Last Name:DILLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:MILLERS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:28651-0664
Mailing Address - Country:US
Mailing Address - Phone:828-295-2241
Mailing Address - Fax:
Practice Address - Street 1:3505 BAMBOO RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-9673
Practice Address - Country:US
Practice Address - Phone:336-902-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106369Medicaid