Provider Demographics
NPI:1437518487
Name:GREENE, CAROL (CADC II)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SW FRAZER AVE
Mailing Address - Street 2:SUITE 282
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2163
Mailing Address - Country:US
Mailing Address - Phone:541-276-7824
Mailing Address - Fax:541-278-0353
Practice Address - Street 1:17 SW FRAZER AVE
Practice Address - Street 2:SUITE 282
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2163
Practice Address - Country:US
Practice Address - Phone:541-276-7824
Practice Address - Fax:541-278-0353
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-12-81101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)