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General NPI Number Information
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NPI Number | 1225110638
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Entity Type | Individual
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Provider Name | GRETA MCCAA WILEY LAC, CCGC
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3200 CONCORDIA AVE
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City | MONROE
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State | LA
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Zip | 71201-5113
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Country | US
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Telephone | 318-362-5188
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Fax | 318-362-5215
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Provider Business Mailing Address
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Address Line | 189 OSCAR RD
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City | WEST MONROE
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State | LA
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Zip | 71292-1298
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Country | US
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Telephone | 318-362-5186
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Fax | 318-362-5215
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 879
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License Number State | LA
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