Provider Demographics
NPI:1790099596
Name:GREENLEAF WHITNEY, HOLLY JAN
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:JAN
Last Name:GREENLEAF WHITNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04654-5124
Mailing Address - Country:US
Mailing Address - Phone:207-255-0184
Mailing Address - Fax:
Practice Address - Street 1:66 CUTLER RD
Practice Address - Street 2:
Practice Address - City:EAST MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04630-4238
Practice Address - Country:US
Practice Address - Phone:207-255-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health