Healthcare Provider Details

I. General information

NPI: 1881316651
Provider Name (Legal Business Name): T GREEN COUNSELING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CORPORATE DR STE 301
STAFFORD VA
22554-4889
US

IV. Provider business mailing address

800 CORPORATE DR STE 301
STAFFORD VA
22554-4889
US

V. Phone/Fax

Practice location:
  • Phone: 862-237-6791
  • Fax: 888-307-5343
Mailing address:
  • Phone: 862-237-6791
  • Fax: 888-307-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TIFFANY NOEL GREEN
Title or Position: OWNER/ OUTPATIENT THERAPIST
Credential: MA, LPC, NCC
Phone: 862-237-6791