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General NPI Number Information
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NPI Number | 1124597638
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Entity Type | Individual
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Provider Name | MRS. TAMMY M GREEN
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Gender | Female
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 2351 FREEDOM WAY
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City | YORK
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State | PA
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Zip | 17402-9282
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Country | US
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Telephone | 717-600-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 2812 BACHMAN CT
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City | MANCHESTER
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State | MD
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Zip | 21102-1725
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Country | US
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Telephone |
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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 | LGP9177
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License Number State | MD
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