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General NPI Number Information
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NPI Number | 1003472101
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Entity Type | Individual
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Provider Name | ALICIA CAROL GREATHOUSE
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Gender | Female
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 103 W MARKET ST
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City | WARREN
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State | OH
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Zip | 44481-1017
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Country | US
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Telephone | 330-394-8831
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Fax |
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Provider Business Mailing Address
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Address Line | 357 6TH ST
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City | CAMPBELL
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State | OH
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Zip | 44405-1253
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Country | US
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Telephone | 330-271-9912
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CDCA166934
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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