MEDICARE: KIMBERLY D. GREEN M.ED, LMFT

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	106H00000X	Marriage & Family Therapist	LF00002194	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275514077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY D. GREEN M.ED, LMFT

Provider Business Mailing Address
First Line	:	667 SPRING DRIVE EXT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-9788
Country	:	US
Telephone Number	:	253-225-5418
Fax Number	:	877-410-5513

Provider Business Practice Location Address
First Line	:	667 SPRING DRIVE EXT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-9788
Country	:	US
Telephone Number	:	253-225-5418
Fax Number	:	877-410-5513

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/07/2022

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