Provider Demographics
NPI:1770358756
Name:GREEN RIVER COUNSELING LLC
Entity type:Organization
Organization Name:GREEN RIVER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVENING
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINEROCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:603-801-7543
Mailing Address - Street 1:5024 CATHARINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1628
Mailing Address - Country:US
Mailing Address - Phone:603-801-7543
Mailing Address - Fax:
Practice Address - Street 1:701 S 50TH ST FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1689
Practice Address - Country:US
Practice Address - Phone:347-470-9084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty