Provider Demographics
NPI:1952093304
Name:CARTER, GLENDA (LPC)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N MAIN ST UNIT 1355
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3298
Mailing Address - Country:US
Mailing Address - Phone:404-510-9660
Mailing Address - Fax:
Practice Address - Street 1:6726 TARA BLVD APT 15G
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1427
Practice Address - Country:US
Practice Address - Phone:404-510-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013928101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor