Healthcare Provider Details

I. General information

NPI: 1750712758
Provider Name (Legal Business Name): DONTRYSE GREER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 WASHINGTON ST W
CHARLESTON WV
25302-2036
US

IV. Provider business mailing address

PO BOX 20580
CHARLESTON WV
25362-1580
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-9834
  • Fax: 304-344-1756
Mailing address:
  • Phone: 304-344-9834
  • Fax: 304-344-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115815
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number260274
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number21213879
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberSW71312860
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: