Provider Demographics
NPI:1700078466
Name:GLINKA, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:GLINKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9616
Mailing Address - Country:US
Mailing Address - Phone:530-926-0531
Mailing Address - Fax:
Practice Address - Street 1:1515 S OREGON ST
Practice Address - Street 2:STE. A
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3425
Practice Address - Country:US
Practice Address - Phone:530-842-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW221161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical