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General NPI Number Information
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NPI Number | 1073157665
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Entity Type | Individual
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Provider Name | PRESTON GREENE LMSW, CAADC
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Gender | Male
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 8484 M 119 UNIT 17B
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City | HARBOR SPRINGS
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State | MI
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Zip | 49740-9542
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Country | US
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Telephone | 231-535-2822
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Fax |
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Provider Business Mailing Address
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Address Line | 514 AMERICAS WAY APT 12518
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City | BOX ELDER
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State | SD
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Zip | 57719-7600
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Country | US
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Telephone | 231-881-2538
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801014042
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License Number State | MI
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