Provider Demographics
NPI:1831674936
Name:GREENE, DIAMOND (LCMFT)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-6327
Mailing Address - Country:US
Mailing Address - Phone:443-827-3124
Mailing Address - Fax:
Practice Address - Street 1:12 ESTATES CT
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6917
Practice Address - Country:US
Practice Address - Phone:443-827-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD38-3876389Medicaid