Provider Demographics
NPI:1477360618
Name:GREENE, ELIZABETH REGINA (LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:REGINA
Last Name:GREENE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 NORWICH CT
Mailing Address - Street 2:
Mailing Address - City:PORT TOBACCO
Mailing Address - State:MD
Mailing Address - Zip Code:20677-3430
Mailing Address - Country:US
Mailing Address - Phone:540-840-1593
Mailing Address - Fax:
Practice Address - Street 1:8015 NORWICH CT
Practice Address - Street 2:
Practice Address - City:PORT TOBACCO
Practice Address - State:MD
Practice Address - Zip Code:20677-3430
Practice Address - Country:US
Practice Address - Phone:540-840-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional