Provider Demographics
NPI:1982746483
Name:GLOVER, LORRAINE ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:ANN
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 ERICKSEN AVE NE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1875
Mailing Address - Country:US
Mailing Address - Phone:206-842-9949
Mailing Address - Fax:206-780-0824
Practice Address - Street 1:785 ERICKSEN AVE NE
Practice Address - Street 2:SUITE 117
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1875
Practice Address - Country:US
Practice Address - Phone:206-842-9949
Practice Address - Fax:206-780-0824
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA020703LH00004322101YM0800X
WA020704LW000051401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical