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General NPI Number Information
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NPI Number | 1699813584
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Entity Type | Individual
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Provider Name | ERIC TODD GREENE LPC CSAC
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 43 CHAMPIONS AVENUE
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City | BIG STONE GAP
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State | VA
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Zip | 24219
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Country | US
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Telephone | 276-523-8300
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Fax | 423-467-3644
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Provider Business Mailing Address
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Address Line | 1167 SPRATLIN PARK DRIVE
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City | GRAY
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State | TN
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Zip | 37615-6205
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Country | US
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Telephone | 423-467-3600
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Fax | 423-467-3644
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0710101620 CSAC
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0701003240 LPC
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003240
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License Number State | VA
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