Healthcare Provider Details

I. General information

NPI: 1073449211
Provider Name (Legal Business Name): GREENLIFE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 VANDORA SPRINGS RD UNIT 115
GARNER NC
27529-3546
US

IV. Provider business mailing address

1002 VANDORA SPRINGS RD UNIT 115
GARNER NC
27529-3546
US

V. Phone/Fax

Practice location:
  • Phone: 984-584-8833
  • Fax:
Mailing address:
  • Phone: 984-584-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DAWN SMITH
Title or Position: THERAPIST/OWNER
Credential: LCSW
Phone: 984-584-8833