Provider Demographics
NPI:1972945921
Name:GREENAWAY, KHALID TSALANI
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:TSALANI
Last Name:GREENAWAY
Suffix:
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 1:1524 BALLARD CT
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7938
Mailing Address - Country:US
Mailing Address - Phone:336-253-5286
Mailing Address - Fax:336-282-6881
Practice Address - Street 1:2309 W CONE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4047
Practice Address - Country:US
Practice Address - Phone:336-282-3445
Practice Address - Fax:336-282-6881
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health