MEDICARE: MORGAN GREEN LPC

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	101YP2500X	Professional Counselor	LPC013886	GA

General Provider Information

NPI Number	:	1588408181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN GREEN LPC

Provider Business Mailing Address
First Line	:	519 BROAD ST STE 202
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-1736
Country	:	US
Telephone Number	:	706-314-8625
Fax Number	:

Provider Business Practice Location Address
First Line	:	519 BROAD ST STE 202
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-1736
Country	:	US
Telephone Number	:	706-314-8625
Fax Number	:

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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Directions to “ MORGAN GREEN LPC” Practice Location

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