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NPI Code Detail

MEDICARE: DONOVAN GREENLEE LCSWA

MEDICARE: DONOVAN GREENLEE LCSWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerP016821NC

General Provider Information

NPI Number : 1457083917
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONOVAN GREENLEE LCSWA
Provider Business Mailing Address
First Line : 1216 MANN DR
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-5512
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1216 MANN DR
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-5512
Country : US
Telephone Number : 508-521-2200
Fax Number : 508-584-2227
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2022
Last Update Date : 06/24/2022

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Directions to “ DONOVAN GREENLEE LCSWA” Practice Location

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