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General NPI Number Information
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NPI Number | 1124291786
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Entity Type | Organization
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Legal Business Name | ROBERT A GREEN PHD AND ASSOCIATES PA
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 16147 LANCASTER HWY SUITE 110
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City | CHARLOTTE
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State | NC
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Zip | 28277-2050
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Country | US
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Telephone | 704-887-4909
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Fax | 954-581-5630
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Provider Business Mailing Address
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Address Line | 16147 LANCASTER HWY SUITE 110
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City | CHARLOTTE
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State | NC
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Zip | 28277-2050
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Country | US
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Telephone | 704-887-4909
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Fax | 954-581-5630
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. ROBERT A GREEN
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Credential | PH.D.
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Telephone | 704-887-4909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3499
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License Number State | NC
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