Provider Demographics
NPI:1669578027
Name:SCARBORO, GLENN N (LCSW)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:N
Last Name:SCARBORO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 MAIN STREET, SUITE 5
Mailing Address - Street 2:COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1800
Mailing Address - Country:US
Mailing Address - Phone:434-792-2277
Mailing Address - Fax:434-792-2279
Practice Address - Street 1:500 PINEY FOREST RD
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-3315
Practice Address - Country:US
Practice Address - Phone:434-792-7437
Practice Address - Fax:434-792-7434
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010268907Medicaid