Basic Information
| Provider Information | |||||||||
| NPI: | 1598265670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLEWEN | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 LAFAYETTE AVE SE STE 3000 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166856919 | ||||||||
| FaxNumber: | 6166853063 | ||||||||
| Practice Location | |||||||||
| Address1: | 667 BANNOCK ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036024830 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2018 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 6801100860 | MI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 6801106474 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | CSW.09927888 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.