Provider Demographics
NPI:1164555157
Name:GREENE, JOLONDA TOMEKA (MA, LPC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:JOLONDA
Middle Name:TOMEKA
Last Name:GREENE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
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 532
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31310-0532
Mailing Address - Country:US
Mailing Address - Phone:912-572-6353
Mailing Address - Fax:912-920-7620
Practice Address - Street 1:445 ELMA G MILES PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3230
Practice Address - Country:US
Practice Address - Phone:912-572-6353
Practice Address - Fax:912-920-7620
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional