Provider Demographics
NPI:1245554500
Name:SHORT, GLENDA F (PHD, LCSW, AAMFT/S)
Entity type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:F
Last Name:SHORT
Suffix:
Gender:F
Credentials:PHD, LCSW, AAMFT/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PARKWAY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7165
Mailing Address - Country:US
Mailing Address - Phone:828-262-5109
Mailing Address - Fax:
Practice Address - Street 1:133 PARKWAY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7165
Practice Address - Country:US
Practice Address - Phone:828-262-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052801041C0700X
NC12600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist