Provider Demographics
NPI:1730756040
Name:GLEEN, ERIKA BRIANNA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:BRIANNA
Last Name:GLEEN
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 1:92 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAYSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35073-1824
Mailing Address - Country:US
Mailing Address - Phone:205-382-5246
Mailing Address - Fax:
Practice Address - Street 1:92 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:GRAYSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35073-1824
Practice Address - Country:US
Practice Address - Phone:205-382-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health