Basic Information
Provider Information
NPI: 1003292814
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GLOVER
FirstName: AMBER
MiddleName: MEDLIN
NamePrefix: MS.
NameSuffix:  
Credential: LCSWA, LCAS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MEDLIN
OtherFirstName: AMBER
OtherMiddleName: LEA
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 10130 PERIMETER PKWY STE 200
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282160197
CountryCode: US
TelephoneNumber: 8888497379
FaxNumber: 8558577333
Practice Location
Address1: 101 CABARRUS AVE E STE 200
Address2:  
City: CONCORD
State: NC
PostalCode: 280253781
CountryCode: US
TelephoneNumber: 8557432247
FaxNumber: 8558577333
Other Information
ProviderEnumerationDate: 08/04/2015
LastUpdateDate: 09/05/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400XLCAS-22213NCN Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
1041C0700XC010991NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical
1041C0700XP009827NCN Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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