Basic Information
Provider Information
NPI: 1124770227
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GLEBER
FirstName: DANIELLE
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 JEFFERSON ST STE 2C
Address2:  
City: LYNCHBURG
State: VA
PostalCode: 245041724
CountryCode: US
TelephoneNumber: 8552847483
FaxNumber: 6178070958
Practice Location
Address1: 2700 LIGHTHOUSE PT E STE 220
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212244773
CountryCode: US
TelephoneNumber: 8552847483
FaxNumber: 6178070958
Other Information
ProviderEnumerationDate: 01/20/2022
LastUpdateDate: 01/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X23990MDY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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