MEDICARE: ASHLEY GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC016542	GA

General Provider Information

NPI Number	:	1003758657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GREEN

Provider Business Mailing Address
First Line	:	1690 STONE VILLAGE LN NW STE 622
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-7777
Country	:	US
Telephone Number	:	678-740-3578
Fax Number	:

Provider Business Practice Location Address
First Line	:	1690 STONE VILLAGE LN NW STE 622
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-7777
Country	:	US
Telephone Number	:	678-740-3578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	06/16/2026

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Directions to “ ASHLEY GREEN ” Practice Location

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