Individual
MR. ANTHONY EUGENE GREENIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AZ LISAC - 15204
Contact information
Practice address
17446 W PAPAGO ST, GOODYEAR, AZ 85338-1903
(919) 827-6628
Mailing address
17446 W PAPAGO ST, GOODYEAR, AZ 85338-1903
(919) 827-6628
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1322
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
15204
AZ
Other
Enumeration date
12/11/2008
Last updated
09/30/2021
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