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Individual

GLENN WILBUR SCANES JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1823 BUSINESS PARK BLVD, DAYTONA BEACH, FL 32114-1230
(386) 255-5818
(386) 255-5818
Mailing address
100 BENT TREE DR, DAYTONA BEACH, FL 32114-1195
(321) 213-8065

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
SOJXQXJM6
FL
Enumeration date
06/03/2019
Last updated
06/03/2019
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