Healthcare Provider Details

I. General information

NPI: 1386154318
Provider Name (Legal Business Name): JACQUELYNNE MICHELLE GRECO MA, LCMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 LAMAR AVE STE 208
CHARLOTTE NC
28204-2436
US

IV. Provider business mailing address

PO BOX 18172
CHARLOTTE NC
28218-0172
US

V. Phone/Fax

Practice location:
  • Phone: 980-222-4431
  • Fax: 704-303-9241
Mailing address:
  • Phone: 980-222-4431
  • Fax: 704-303-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13166
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: