Provider Demographics
NPI:1295358737
Name:GREENE, NANCY ALISON (DSW)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ALISON
Last Name:GREENE
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19005 SERENITY POINT LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8811
Mailing Address - Country:US
Mailing Address - Phone:704-775-6264
Mailing Address - Fax:
Practice Address - Street 1:19005 SERENITY POINT LN
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8811
Practice Address - Country:US
Practice Address - Phone:704-775-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0097211041C0700X
FLSW171371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty