Provider Demographics
NPI:1750712758
Name:GREER, DONTRYSE
Entity type:Individual
Prefix:
First Name:DONTRYSE
Middle Name:
Last Name:GREER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20580
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25362-1580
Mailing Address - Country:US
Mailing Address - Phone:304-344-9834
Mailing Address - Fax:304-344-1756
Practice Address - Street 1:510 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2036
Practice Address - Country:US
Practice Address - Phone:304-344-9834
Practice Address - Fax:304-344-1756
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY212138791041S0200X
TX1158151041C0700X
WVSW71312860171M00000X
KY2602741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator