Provider Information for 1578878849
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MICHELL GREENIDGE LCSW
Sex: Female
NPI: 1578878849
Last Updated: 2021-12-21
Certification Date: 2021-12-21
Certification Date: 2021-12-21
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1578878849 | ||||||||
| Enumeration Date | 2010-08-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 221 3RD ST W JBSA RANDOLPH, TX 78150-4800 United States Phone: 210-565-0696 | Fax: | ||||||||
| Primary Practice Address | 221 3RD ST W JBSA RANDOLPH, TX 78150-4800 United States Phone: 210-565-0696 | Fax: | ||||||||
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