Provider Demographics
NPI:1366575045
Name:GLOEGE, DONALD JAMES (LCSW, LISW-CP, BCD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JAMES
Last Name:GLOEGE
Suffix:
Gender:M
Credentials:LCSW, LISW-CP, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WICHITA DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-7763
Mailing Address - Country:US
Mailing Address - Phone:704-434-8952
Mailing Address - Fax:
Practice Address - Street 1:825 E KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3186
Practice Address - Country:US
Practice Address - Phone:980-487-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86631041C0700X
NCC0047031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002-908Medicaid
NC2879828AMedicare PIN
NC2879828BMedicare PIN