Provider Demographics
NPI:1780347062
Name:GLOVER, DAULPHINIA ARLETTA (MA,CDCA)
Entity type:Individual
Prefix:
First Name:DAULPHINIA
Middle Name:ARLETTA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MA,CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WALES AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2398
Mailing Address - Country:US
Mailing Address - Phone:804-867-7338
Mailing Address - Fax:
Practice Address - Street 1:2520 WALES AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2398
Practice Address - Country:US
Practice Address - Phone:234-262-1112
Practice Address - Fax:330-837-2341
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-10136-M101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH-10136-MMedicaid