Provider Demographics
NPI:1417977604
Name:GREENE, MARY MOREHOUSE (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MOREHOUSE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16131 PLESS MILL RD
Mailing Address - Street 2:
Mailing Address - City:STANFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28163-7570
Mailing Address - Country:US
Mailing Address - Phone:704-485-3564
Mailing Address - Fax:
Practice Address - Street 1:301 YADKIN ST.
Practice Address - Street 2:STANLY REGIONAL MEDICAL CENTER
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28002
Practice Address - Country:US
Practice Address - Phone:704-874-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128R8OtherBLUE CROSS AND BLUE SHIEL