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General NPI Number Information
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NPI Number | 1134680366
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Entity Type | Individual
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Provider Name | SHERYLL LAFAY GREEN LPC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 03/29/2019
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Provider Practice Location Address
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Address Line | 1801 HAYWARD AVE
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2231
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Country | US
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Telephone | 757-390-2098
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Fax |
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Provider Business Mailing Address
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Address Line | 3888 WHITLEY PARK DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-5763
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Country | US
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Telephone | 202-725-0248
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701008205
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License Number State | VA
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