Provider Demographics
NPI:1396070694
Name:GREENE, JAMES (MFT TRAINEE)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT TRAINEE
Mailing Address - Street 1:4660 EL CAJON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4450
Mailing Address - Country:US
Mailing Address - Phone:619-640-3266
Mailing Address - Fax:619-640-3269
Practice Address - Street 1:4660 EL CAJON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4450
Practice Address - Country:US
Practice Address - Phone:619-640-3266
Practice Address - Fax:619-640-3269
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health