Provider Demographics
NPI:1124664172
Name:GREENE, DEIDRE MICHELLE
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:MICHELLE
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13105 21ST DR SE APT E307
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7173
Mailing Address - Country:US
Mailing Address - Phone:425-499-8058
Mailing Address - Fax:
Practice Address - Street 1:13105 21ST DR SE APT E307
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7173
Practice Address - Country:US
Practice Address - Phone:425-499-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)