Individual
MRS. HOLLY GREENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SAC IT
Contact information
Practice address
111 WARREN ST, SUITE #2, BEAVER DAM, WI 53916-3084
(920) 219-4440
Mailing address
W207N17003 PARKVIEW CT, JACKSON, WI 53037-9459
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18008-130
WI
Other
Enumeration date
03/31/2017
Last updated
03/31/2017
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