Organization
THE G.L.U. CLUB, LLC
Active
Organization
THE G.L.U. CLUB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY MASSEY (PROGRAM DIRECTOR)
(704) 712-6998
Entity
Organization
Contact information
Practice address
9156 EVENTINE CT, CHARLOTTE, NC 28214-9323
(704) 712-6998
Mailing address
9156 EVENTINE CT, CHARLOTTE, NC 28214-9323
(704) 712-6998
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
251B00000X
Case Management Agency
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
03/24/2011
Last updated
03/24/2011
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