Provider Demographics
NPI:1225325046
Name:GREENE, MERRILEE DIANE (CADC II)
Entity Type:Individual
Prefix:
First Name:MERRILEE
Middle Name:DIANE
Last Name:GREENE
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E ORANGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7056
Mailing Address - Country:US
Mailing Address - Phone:714-633-1927
Mailing Address - Fax:
Practice Address - Street 1:2607 WILLO LN
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4645
Practice Address - Country:US
Practice Address - Phone:949-313-1192
Practice Address - Fax:949-574-8977
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA5370111101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)