Healthcare Provider Details

I. General information

NPI: 1689061301
Provider Name (Legal Business Name): JAYNE' GREEN LPC, LMHC, CAMS II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 GLENRIDGE DR
SANDY SPRINGS GA
30328-5574
US

IV. Provider business mailing address

3919 GARDENWOOD CIR
GRANT VALKARIA FL
32949-8244
US

V. Phone/Fax

Practice location:
  • Phone: 404-519-0080
  • Fax:
Mailing address:
  • Phone: 407-271-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010885
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: