Provider Demographics
NPI:1982783155
Name:GREENE, WILLIE E (LPC)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:E
Last Name:GREENE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BRONCO DR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-2214
Mailing Address - Country:US
Mailing Address - Phone:229-931-2470
Mailing Address - Fax:
Practice Address - Street 1:107 BRONCO DR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-2214
Practice Address - Country:US
Practice Address - Phone:229-931-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional