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General NPI Number Information
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NPI Number | 1487856365
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Entity Type | Individual
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Provider Name | SULAN M GREEN MSW
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 200 ARNET ST SUITE 200
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City | YPSILANTI
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State | MI
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Zip | 48198-5753
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Country | US
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Telephone | 734-482-6221
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 S STATE ST 700 KMS PLACE
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City | ANN ARBOR
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State | MI
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Zip | 48108
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Country | US
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Telephone | 734-936-2047
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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 | 6801087295
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801087295
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License Number State | MI
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