Provider Demographics
NPI:1295507341
Name:GREENPSYCH WELLNESS LLC
Entity type:Organization
Organization Name:GREENPSYCH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JUNYONG
Authorized Official - Middle Name:
Authorized Official - Last Name:JIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-330-0054
Mailing Address - Street 1:3 SPRINGER CT
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5545
Mailing Address - Country:US
Mailing Address - Phone:202-340-0082
Mailing Address - Fax:
Practice Address - Street 1:8929 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1308
Practice Address - Country:US
Practice Address - Phone:240-330-0054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty