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General NPI Number Information
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NPI Number | 1003521725
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Entity Type | Individual
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Provider Name | SHAWNNETTA N GREEN LAPC
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Gender | Female
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 3464 FAIRBURN RD BLDG 4
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2926
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Country | US
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Telephone | 678-379-3055
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Fax |
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Provider Business Mailing Address
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Address Line | 85 LAKERIDGE DR
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City | TEMPLE
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State | GA
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Zip | 30179-4301
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Country | US
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Telephone | 678-379-3055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APC008679
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License Number State | GA
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