Provider Demographics
NPI:1811648165
Name:GLOW CARE SUPPORT, PLLC
Entity type:Organization
Organization Name:GLOW CARE SUPPORT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTANGA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW-A
Authorized Official - Phone:800-993-3620
Mailing Address - Street 1:8601 SIX FORKS RD STE 400-5340
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5276
Mailing Address - Country:US
Mailing Address - Phone:800-993-3620
Mailing Address - Fax:
Practice Address - Street 1:8601 SIX FORKS RD STE 400-5340
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5276
Practice Address - Country:US
Practice Address - Phone:800-993-3620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty