Provider Demographics
NPI:1417650532
Name:GREENE, MEGAN COURTNEY (CDCA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:COURTNEY
Last Name:GREENE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 JOHNNYCAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6728
Mailing Address - Country:US
Mailing Address - Phone:440-529-5619
Mailing Address - Fax:
Practice Address - Street 1:9920 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6728
Practice Address - Country:US
Practice Address - Phone:440-529-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)