Healthcare Provider Details

I. General information

NPI: 1083222632
Provider Name (Legal Business Name): ALLISON GREEN MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ROLLING HILL RD STE 225
MOORESVILLE NC
28117-8861
US

IV. Provider business mailing address

121 ROLLING HILL RD STE 225
MOORESVILLE NC
28117-8861
US

V. Phone/Fax

Practice location:
  • Phone: 704-534-5997
  • Fax: 704-230-1397
Mailing address:
  • Phone: 704-534-5997
  • Fax: 704-230-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: