Provider Demographics
NPI:1730694928
Name:GREENWOOD COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:GREENWOOD COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-682-0384
Mailing Address - Street 1:132 JOE KNOX AVE STE 100E
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9203
Mailing Address - Country:US
Mailing Address - Phone:704-360-3641
Mailing Address - Fax:704-353-7944
Practice Address - Street 1:132 JOE KNOX AVE STE 100E
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9203
Practice Address - Country:US
Practice Address - Phone:704-360-3641
Practice Address - Fax:704-353-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-10
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health