Provider Demographics
NPI:1003213117
Name:ENRIQUEZ, GRETA (LPC)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101B EMERALD DR # 5605
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-2716
Mailing Address - Country:US
Mailing Address - Phone:252-515-0557
Mailing Address - Fax:252-376-1473
Practice Address - Street 1:8101B EMERALD DR # 5605
Practice Address - Street 2:
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594-2716
Practice Address - Country:US
Practice Address - Phone:252-515-0557
Practice Address - Fax:252-376-1473
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00212800101YM0800X
NC15007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health