Provider Demographics
NPI:1053437384
Name:JOSEPHINE E. GLOVER, DBA
Entity type:Organization
Organization Name:JOSEPHINE E. GLOVER, DBA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:330-453-1373
Mailing Address - Street 1:2719 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3309
Mailing Address - Country:US
Mailing Address - Phone:330-453-1373
Mailing Address - Fax:330-453-1383
Practice Address - Street 1:2719 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3309
Practice Address - Country:US
Practice Address - Phone:330-453-1373
Practice Address - Fax:330-453-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004389 SUPV261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)