Provider Demographics
NPI:1295039154
Name:GREENWOOD, SHELIA MARQUIETTA (CADC)
Entity Type:Individual
Prefix:MRS
First Name:SHELIA
Middle Name:MARQUIETTA
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 227
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-9657
Mailing Address - Country:US
Mailing Address - Phone:580-812-1395
Mailing Address - Fax:580-931-2239
Practice Address - Street 1:RR 3 BOX 227
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448-9657
Practice Address - Country:US
Practice Address - Phone:580-812-1395
Practice Address - Fax:580-931-2239
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK84101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)