Healthcare Provider Details

I. General information

NPI: 1093052169
Provider Name (Legal Business Name): CYNTHIA MARIE GREENE MA LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 OAKMAN BLVD STE D
DETROIT MI
48238-4019
US

IV. Provider business mailing address

21532 RAVEN AVE
EASTPOINTE MI
48021-2785
US

V. Phone/Fax

Practice location:
  • Phone: 313-961-4890
  • Fax:
Mailing address:
  • Phone: 586-777-5156
  • Fax: 586-777-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012727
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6803078874
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401012727
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: