MEDICARE: BRENNA GREEN LMFT-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	20789A	NC

General Provider Information

NPI Number	:	1508722430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA GREEN LMFT-A

Provider Business Mailing Address
First Line	:	203 FRALEY DR
Second Line	:
City	:	INMAN
State	:	SC
Zip	:	29349-6912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 FAIR MEADOWS LN STE 103
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6449
Country	:	US
Telephone Number	:	984-204-1337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ BRENNA GREEN LMFT-A” Practice Location

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