Provider Demographics
NPI:1609638428
Name:GREENE, MADISON (LCMHCA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5014
Mailing Address - Country:US
Mailing Address - Phone:828-322-9130
Mailing Address - Fax:828-322-7890
Practice Address - Street 1:106 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5014
Practice Address - Country:US
Practice Address - Phone:828-322-9130
Practice Address - Fax:828-322-7890
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health