Provider Demographics
NPI:1932149325
Name:GLOVER, CHARLES MARSHALL (LPC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MARSHALL
Last Name:GLOVER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:118 CATHERWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6812
Mailing Address - Country:US
Mailing Address - Phone:919-616-8819
Mailing Address - Fax:866-401-2407
Practice Address - Street 1:515 KEISLER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7097
Practice Address - Country:US
Practice Address - Phone:919-616-8819
Practice Address - Fax:866-401-2407
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2342249OtherGROUP MEDICARE