Individual
MIKKISHA SHARAE GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3806 EASTON BLVD, DES MOINES, IA 50317-5730
(515) 262-0349
Mailing address
3806 EASTON BLVD, DES MOINES, IA 50317-5730
(515) 262-0349
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14117
IA
Other
Enumeration date
12/15/2017
Last updated
12/15/2017
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