Provider Demographics
NPI:1790098135
Name:GREENE, THERESA PAYNE (LCPC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:PAYNE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 DENVER DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6304
Mailing Address - Country:US
Mailing Address - Phone:336-855-7912
Mailing Address - Fax:336-855-9858
Practice Address - Street 1:2514 DENVER DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-6304
Practice Address - Country:US
Practice Address - Phone:336-855-7912
Practice Address - Fax:336-855-9858
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCGR75043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist