Basic Information
| Provider Information | |||||||||
| NPI: | 1821617952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENE | ||||||||
| FirstName: | LAUREN | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BUSH MILL CT | ||||||||
| Address2: | |||||||||
| City: | WINDSOR MILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212441936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434155653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 BENFIELD BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6676002494 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LGP9336 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.