Provider Demographics
NPI:1689016180
Name:GRECO, VICKI (JD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:GRECO
Suffix:
Gender:F
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 S MAIN ST
Mailing Address - Street 2:STE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1027
Mailing Address - Country:US
Mailing Address - Phone:702-544-2650
Mailing Address - Fax:
Practice Address - Street 1:1114 S MAIN ST
Practice Address - Street 2:STE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1027
Practice Address - Country:US
Practice Address - Phone:702-544-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health