Provider Demographics
NPI:1952897878
Name:GRETA FURLONG LMSW PLLC
Entity Type:Organization
Organization Name:GRETA FURLONG LMSW PLLC
Other - Org Name:ACTIVE RESILIENCE TRAINING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FURLONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-604-2651
Mailing Address - Street 1:2565 W ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9639
Mailing Address - Country:US
Mailing Address - Phone:734-604-2651
Mailing Address - Fax:734-827-2175
Practice Address - Street 1:2565 W ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108
Practice Address - Country:US
Practice Address - Phone:734-604-2651
Practice Address - Fax:734-827-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010979411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty