Healthcare Provider Details

I. General information

NPI: 1174434070
Provider Name (Legal Business Name): GREEN HAUS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WOODLAND AVE
MANCHESTER NH
03109-4455
US

IV. Provider business mailing address

200 WOODLAND AVE
MANCHESTER NH
03109-4455
US

V. Phone/Fax

Practice location:
  • Phone: 347-281-0031
  • Fax:
Mailing address:
  • Phone: 347-281-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. DINA M GREEN
Title or Position: OWNER
Credential: PH.D
Phone: 347-281-0031