Individual
GLORY ENI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COUNSELOR
Contact information
Practice address
107 INDUSTRIAL DR STE B, LOUISBURG, NC 27549-2371
(919) 271-9073
(919) 212-8140
Mailing address
3901 CAPITAL BLVD STE 109 PMB 301, RALEIGH, NC 27604-3487
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6111864
—
NC
Enumeration date
02/23/2007
Last updated
07/08/2007
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