Provider Demographics
NPI:1912273129
Name:GREENE, CAROL (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-5739
Mailing Address - Country:US
Mailing Address - Phone:360-385-5717
Mailing Address - Fax:
Practice Address - Street 1:441 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-5739
Practice Address - Country:US
Practice Address - Phone:360-385-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00010487225700000X
WAAC 60535443171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist