Healthcare Provider Details

I. General information

NPI: 1356424493
Provider Name (Legal Business Name): CAROLYN M GREEN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 ESTRELLITA DEL NORTE RD NE
ALBUQUERQUE NM
87111-1653
US

IV. Provider business mailing address

5615 ESTRELLITA DEL NORTE RD NE
ALBUQUERQUE NM
87111-1653
US

V. Phone/Fax

Practice location:
  • Phone: 505-858-3051
  • Fax:
Mailing address:
  • Phone: 505-858-3051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005618
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number005618
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: