Individual
LEROY WILSON GLENN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS
Contact information
Practice address
220 EAST FIRST AVENUE EXTENSION, SUITE 10, LEXINGTON, NC 27292-3355
(336) 242-2450
(336) 249-9920
Mailing address
1404 SANTOLINA LN, LEWISVILLE, NC 27023-8622
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
688
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
688
LCAS
NC
Enumeration date
01/23/2007
Last updated
07/08/2007
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