Provider Demographics
NPI:1245362896
Name:CORWIN, GLENDA RUTH (PHD)
Entity type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:RUTH
Last Name:CORWIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 CENTURY BLVD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3399
Mailing Address - Country:US
Mailing Address - Phone:404-633-0071
Mailing Address - Fax:404-315-9744
Practice Address - Street 1:1780 CENTURY BLVD NE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3399
Practice Address - Country:US
Practice Address - Phone:404-633-0071
Practice Address - Fax:404-315-9744
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001379103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical