Provider Demographics
NPI:1528652617
Name:GREENE, TERRY D (BA, QMHP, CDS)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:D
Last Name:GREENE
Suffix:
Gender:M
Credentials:BA, QMHP, CDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GREENWICH RD STE 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2365
Mailing Address - Country:US
Mailing Address - Phone:980-335-1222
Mailing Address - Fax:
Practice Address - Street 1:121 GREENWICH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2355
Practice Address - Country:US
Practice Address - Phone:980-208-4647
Practice Address - Fax:980-237-9266
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5833253Z00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide