Provider Demographics
NPI:1366508996
Name:GREENE, LINDA SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 STOUT DRIVE BOX 70403
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-733-2121
Mailing Address - Fax:423-733-4563
Practice Address - Street 1:391 COURT STREET
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-0723
Practice Address - Country:US
Practice Address - Phone:423-733-2121
Practice Address - Fax:423-733-4563
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3927834Medicare PIN