Active NPI
Glynis Wikstrom Fullwood, LCSW
- Clinical Social Worker
- Chapel Hill, NC
National Provider Identifier
1902467350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C004458
- Practice address
- 104 S Estes Dr Ste 301G
Chapel Hill, NC 27514-2848 - Phone
- (919) 931-5639
- NPI assigned
- Jun 26, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C004458 | NC | Primary |
Addresses
Primary practice location
104 S Estes Dr Ste 301G
Chapel Hill, NC 27514-2848
Mailing address
104 S Estes Dr Ste 301G
Chapel Hill, NC 27514-2848
Phone (919) 931-5639
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C004458 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561507200000",
"number": "1902467350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 S ESTES DR STE 301G",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275142848",
"telephone_number": "919-931-5639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 S ESTES DR STE 301G",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275142848",
"telephone_number": "919-931-5639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLWOOD",
"first_name": "GLYNIS",
"middle_name": "WIKSTROM",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-26",
"last_updated": "2019-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C004458",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chapel Hill, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.