Provider Demographics
NPI:1700674439
Name:GLAZEBROOK, CAROLYN MARIE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARIE
Last Name:GLAZEBROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14835 PORTERFIELD DR APT 5
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-1265
Mailing Address - Country:US
Mailing Address - Phone:434-989-4478
Mailing Address - Fax:
Practice Address - Street 1:23164 DRAGOON RD
Practice Address - Street 2:
Practice Address - City:LIGNUM
Practice Address - State:VA
Practice Address - Zip Code:22726-2036
Practice Address - Country:US
Practice Address - Phone:434-989-4478
Practice Address - Fax:434-989-4478
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
VA0701014356101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor