Healthcare Provider Details

I. General information

NPI: 1205641925
Provider Name (Legal Business Name): L. L. GREEN AND ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 NUTTALL OAKS PL
BRANDON FL
33510-2179
US

IV. Provider business mailing address

2103 NUTTALL OAKS PL
BRANDON FL
33510-2179
US

V. Phone/Fax

Practice location:
  • Phone: 813-999-3001
  • Fax: 813-819-2619
Mailing address:
  • Phone: 813-999-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATASHA LANEE GREEN-BOYD
Title or Position: ADMINISTRATOR
Credential: LCSW, LICSW, LMFT
Phone: 813-999-3001