Provider Demographics
NPI:1043556210
Name:RITCHIE, GLENN HOWARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:HOWARD
Last Name:RITCHIE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-5432
Mailing Address - Country:US
Mailing Address - Phone:229-456-2022
Mailing Address - Fax:229-352-8792
Practice Address - Street 1:719 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-5432
Practice Address - Country:US
Practice Address - Phone:229-456-2022
Practice Address - Fax:229-352-8792
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0070911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical