Provider Demographics
NPI:1134623648
Name:GREENE, TREY (MSW,LCSWA)
Entity type:Individual
Prefix:
First Name:TREY
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:MSW,LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 MONROE RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7750
Mailing Address - Country:US
Mailing Address - Phone:704-350-5452
Mailing Address - Fax:
Practice Address - Street 1:3800 MONROE RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7750
Practice Address - Country:US
Practice Address - Phone:704-350-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP010637101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health