Provider Demographics
NPI:1912616814
Name:GREENE, DEANNA (CTRS, CCLS, QMHP-C)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:CTRS, CCLS, QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 SADLER ROAD STE 300
Mailing Address - Street 2:#5050
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-762-0063
Mailing Address - Fax:
Practice Address - Street 1:4870 SADLER ROAD STE 300
Practice Address - Street 2:#5050
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-762-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA65504225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist