Provider Demographics
NPI:1902056039
Name:GREENVILLE RECOVERY CENTER
Entity Type:Organization
Organization Name:GREENVILLE RECOVERY CENTER
Other - Org Name:GRC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LCAS, CCS
Authorized Official - Phone:252-353-2555
Mailing Address - Street 1:150 E ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5019
Mailing Address - Country:US
Mailing Address - Phone:252-353-2555
Mailing Address - Fax:252-353-2550
Practice Address - Street 1:150 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5019
Practice Address - Country:US
Practice Address - Phone:252-353-2555
Practice Address - Fax:252-353-2550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELLATI & CO., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-074-167251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health