Provider Demographics
NPI:1033144761
Name:GREENE, DENICE M (LCMHC)
Entity type:Individual
Prefix:
First Name:DENICE
Middle Name:M
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4850
Mailing Address - Country:US
Mailing Address - Phone:704-517-3617
Mailing Address - Fax:704-238-9891
Practice Address - Street 1:107 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4850
Practice Address - Country:US
Practice Address - Phone:704-517-3617
Practice Address - Fax:704-238-9891
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3765101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103126Medicaid