Healthcare Provider Details

I. General information

NPI: 1932054269
Provider Name (Legal Business Name): ERIC JAMES GREENLEE SR. SUDRC1 23267
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 HARRISON ST
SAN FRANCISCO CA
94103-4473
US

IV. Provider business mailing address

75 DORE ST APT 120
SAN FRANCISCO CA
94103-3892
US

V. Phone/Fax

Practice location:
  • Phone: 415-503-3007
  • Fax: 415-252-8577
Mailing address:
  • Phone: 415-503-3007
  • Fax: 415-252-8577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: