Individual
MR. KEVAN GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
860 S. COLUMBIA RD, GRAND FORKS, ND 58201
(701) 780-6697
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-6468
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4610
ND
1041C0700X
Clinical Social Worker
4610
ND
Other
Enumeration date
02/07/2013
Last updated
11/04/2021
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