Provider Demographics
NPI:1548037229
Name:GLASS, MARQUITIA CHENELL (LPC)
Entity type:Individual
Prefix:
First Name:MARQUITIA
Middle Name:CHENELL
Last Name:GLASS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 DUNCAN RD APT B
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-7490
Mailing Address - Country:US
Mailing Address - Phone:804-712-0340
Mailing Address - Fax:
Practice Address - Street 1:6141 DUNCAN RD APT B
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-7490
Practice Address - Country:US
Practice Address - Phone:804-712-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional