Provider Demographics
NPI:1891533907
Name:GREENE, TIRRELL III
Entity type:Individual
Prefix:
First Name:TIRRELL
Middle Name:
Last Name:GREENE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480775
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5306
Mailing Address - Country:US
Mailing Address - Phone:412-923-8092
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 480775
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-5306
Practice Address - Country:US
Practice Address - Phone:412-923-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician