Healthcare Provider Details

I. General information

NPI: 1093456378
Provider Name (Legal Business Name): GREENE MENTAL WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 WAKE FOREST BUSINESS PARK STE F
WAKE FOREST NC
27587-7184
US

IV. Provider business mailing address

6621 PRESCOTT SHORE DR
WAKE FOREST NC
27587-8564
US

V. Phone/Fax

Practice location:
  • Phone: 919-230-1419
  • Fax: 984-278-6610
Mailing address:
  • Phone: 919-667-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: CATINA GREENE
Title or Position: OWNER
Credential: DNP, PMHNP, FNP
Phone: 919-667-5888