Provider Demographics
NPI:1306903976
Name:GREENE-HOLMES, EVELYN AMELIA (MA, LPC, CJC, LCADC)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:AMELIA
Last Name:GREENE-HOLMES
Suffix:
Gender:F
Credentials:MA, LPC, CJC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 JOANNE DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4934
Mailing Address - Country:US
Mailing Address - Phone:856-282-6636
Mailing Address - Fax:856-545-7962
Practice Address - Street 1:20 JOANNE DR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4934
Practice Address - Country:US
Practice Address - Phone:856-282-6636
Practice Address - Fax:856-545-7962
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00081800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223822251OtherFEDERAL TAX ID NUMBER