Provider Demographics
NPI:1669886925
Name:GLAVIN, REBECCA EVE (MBA, MSW, LCSW-A)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:EVE
Last Name:GLAVIN
Suffix:
Gender:F
Credentials:MBA, MSW, LCSW-A
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:EVE
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4724 PARK RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2265
Mailing Address - Country:US
Mailing Address - Phone:980-231-1902
Mailing Address - Fax:253-595-7574
Practice Address - Street 1:4724 PARK RD
Practice Address - Street 2:SUITE A1
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2265
Practice Address - Country:US
Practice Address - Phone:980-231-1902
Practice Address - Fax:253-595-7574
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-1274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health