Provider Demographics
NPI:1386154318
Name:GRECO, JACQUELYNNE MICHELLE (MA, LPCA, NCC)
Entity type:Individual
Prefix:MS
First Name:JACQUELYNNE
Middle Name:MICHELLE
Last Name:GRECO
Suffix:
Gender:F
Credentials:MA, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16026 WOODCOTE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5743
Mailing Address - Country:US
Mailing Address - Phone:704-562-5245
Mailing Address - Fax:
Practice Address - Street 1:18809 W CATAWBA AVE STE 202
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5548
Practice Address - Country:US
Practice Address - Phone:704-840-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427217702OtherPRACTICE NPI