Provider Demographics
NPI:1083055594
Name:MIKUS, GRETA
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:MIKUS
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 1:407 MULBERRY ST SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5722
Mailing Address - Country:US
Mailing Address - Phone:828-394-6720
Mailing Address - Fax:828-394-6721
Practice Address - Street 1:407 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5722
Practice Address - Country:US
Practice Address - Phone:828-394-6797
Practice Address - Fax:828-394-6721
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1795106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor