Provider Demographics
NPI:1265208565
Name:COUNCIL, GLORIA SAMANTHA (LCCT)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:SAMANTHA
Last Name:COUNCIL
Suffix:
Gender:F
Credentials:LCCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 MOSS STREAM LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-8846
Mailing Address - Country:US
Mailing Address - Phone:704-492-8899
Mailing Address - Fax:
Practice Address - Street 1:2241B BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4311
Practice Address - Country:US
Practice Address - Phone:704-492-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSGC129795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty