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General NPI Number Information
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NPI Number | 1275514077
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Entity Type | Individual
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Provider Name | KIMBERLY D. GREEN M.ED, LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 667 SPRING DRIVE EXT
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City | WINSTON SALEM
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State | NC
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Zip | 27107-9788
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Country | US
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Telephone | 253-225-5418
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Fax | 877-410-5513
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Provider Business Mailing Address
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Address Line | 667 SPRING DRIVE EXT
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City | WINSTON SALEM
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State | NC
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Zip | 27107-9788
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Country | US
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Telephone | 253-225-5418
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Fax | 877-410-5513
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00002194
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License Number State | WA
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