Provider Demographics
NPI:1619429388
Name:GREENBROOK TMS NORTH RALEIGH LLC
Entity Type:Organization
Organization Name:GREENBROOK TMS NORTH RALEIGH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-259-8193
Mailing Address - Street 1:8405 GREENSBORO DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-5104
Mailing Address - Country:US
Mailing Address - Phone:855-910-4867
Mailing Address - Fax:855-920-4867
Practice Address - Street 1:701 EXPOSITION PL STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3359
Practice Address - Country:US
Practice Address - Phone:855-910-4867
Practice Address - Fax:855-920-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center