Healthcare Provider Details

I. General information

NPI: 1467809715
Provider Name (Legal Business Name): RA'SHAD GREEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 ESPLANADE AVE
NEW ORLEANS LA
70116
US

IV. Provider business mailing address

1406 ESPLANADE AVE
NEW ORLEANS LA
70116-1803
US

V. Phone/Fax

Practice location:
  • Phone: 504-304-4097
  • Fax:
Mailing address:
  • Phone: 504-304-4097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: