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General NPI Number Information
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NPI Number | 1649332644
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Entity Type | Individual
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Provider Name | AUDREY GREEN-CAMPBELL
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 12/09/2023
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Provider Practice Location Address
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Address Line | 224 CENTRAL LN
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City | TIFTON
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State | GA
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Zip | 31794-4423
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Country | US
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Telephone | 804-869-1096
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Fax |
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Provider Business Mailing Address
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Address Line | 2823 RAINWATER RD
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City | TIFTON
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State | GA
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Zip | 31793-5700
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Country | US
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Telephone | 804-869-1096
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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 | LPC009467
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003962
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License Number State | VA
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