Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1151 | LA |
NPI | 1003095068 |
---|---|
Provider Name | Tracy Greenwood |
First Address | Morgan City, LA 70380-2247 |
Second Address | Morgan City, LA 70380-2247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2007 |
Last Update Date | 01/05/2015 |