MEDICARE: MS. CHELSEA ELIZABETH GREENE MASTERS DEGREE PSYCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	9115	NC

General Provider Information

NPI Number	:	1972737401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHELSEA ELIZABETH GREENE MASTERS DEGREE PSYCH

Provider Business Mailing Address
First Line	:	1851 W EHRINGHAUS ST STE 180
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4555
Country	:	US
Telephone Number	:	910-585-3407
Fax Number	:	910-585-3407

Provider Business Practice Location Address
First Line	:	1851 W EHRINGHAUS ST STE 180
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4555
Country	:	US
Telephone Number	:	910-585-3407
Fax Number	:	910-585-3407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	12/16/2021

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