Provider Demographics
NPI:1225110638
Name:WILEY, GRETA MCCAA (LAC, CCGC)
Entity Type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:MCCAA
Last Name:WILEY
Suffix:
Gender:F
Credentials:LAC, CCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 OSCAR RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-1298
Mailing Address - Country:US
Mailing Address - Phone:318-362-5186
Mailing Address - Fax:318-362-5215
Practice Address - Street 1:3200 CONCORDIA AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5113
Practice Address - Country:US
Practice Address - Phone:318-362-5188
Practice Address - Fax:318-362-5215
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA879101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)