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General NPI Number Information
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NPI Number | 1164920591
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Entity Type | Individual
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Provider Name | ANGELA MARIE GREEN MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 199 SPOTNAP RD STE 6A
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-8827
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Country | US
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Telephone | 434-414-1855
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Fax |
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Provider Business Mailing Address
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Address Line | 199 SPOTNAP RD STE 6A
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-8827
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Country | US
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Telephone | 434-414-1855
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0701007474
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701007474
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007474
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License Number State | VA
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