Provider Demographics
NPI:1093052169
Name:GREENE, CYNTHIA MARIE (MA LLPC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:GREENE
Suffix:
Gender:F
Credentials:MA LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21532 RAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2785
Mailing Address - Country:US
Mailing Address - Phone:586-777-5156
Mailing Address - Fax:586-777-6178
Practice Address - Street 1:28475 GREENFIELD RD
Practice Address - Street 2:STE. 213
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3034
Practice Address - Country:US
Practice Address - Phone:586-344-3176
Practice Address - Fax:586-777-6178
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012727101YM0800X, 101YP2500X
MI6803078874104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker