Healthcare Provider Details

I. General information

NPI: 1073122073
Provider Name (Legal Business Name): CHELSEA ALEXIS GREEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3552 HABERSHAM AT NORTHLAKE BLDG G
TUCKER GA
30084-4009
US

IV. Provider business mailing address

3552 HABERSHAM AT NORTHLAKE BLDG G
TUCKER GA
30084-4009
US

V. Phone/Fax

Practice location:
  • Phone: 678-600-6873
  • Fax:
Mailing address:
  • Phone: 678-600-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC013357
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: