| Glory Days Support Service, Llc | |
|
625 Piney Forest Rd, Suite 302c, Same Danville VA 24540 | |
| (434) 421-2196 | |
| (434) 688-4713 |
| Full Name | Glory Days Support Service, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 625 Piney Forest Rd, Suite 302c,, Danville, Virginia |
| Authorized Official Name and Position | Camilla Kayceo Henry Petty (CEO/OWNER) |
| Authorized Official Contact | 4346884711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glory Days Support Service, Llc 625 Piney Forest Rd, Suite 302c, Same Danville VA 24540 Ph: (434) 421-2196 | Glory Days Support Service, Llc 625 Piney Forest Rd, Suite 302c, Same Danville VA 24540 Ph: (434) 421-2196 |
| NPI Number | 1619514312 |
|---|---|
| Provider Enumeration Date | 12/02/2019 |
| Last Update Date | 12/02/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619514312 | NPI | - | NPPES |
| T60227306 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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