Provider Demographics
NPI:1780723551
Name:GLASS, MARIANA R (MA)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:R
Last Name:GLASS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GRIFFING BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2855
Mailing Address - Country:US
Mailing Address - Phone:828-254-0813
Mailing Address - Fax:
Practice Address - Street 1:188 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1923
Practice Address - Country:US
Practice Address - Phone:828-230-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133TWOtherBLUECROSS BLUESHIELD NC