Healthcare Provider Details

I. General information

NPI: 1912636861
Provider Name (Legal Business Name): HILLARY GREEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIDGWAY RD
PINE BLUFF AR
71603-7633
US

IV. Provider business mailing address

1301 RIDGWAY RD
PINE BLUFF AR
71603-7633
US

V. Phone/Fax

Practice location:
  • Phone: 870-395-7341
  • Fax:
Mailing address:
  • Phone: 870-395-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8966C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: