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NPI Code Detail

MEDICARE: KELSEY GREEN

MEDICARE: KELSEY 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
1101YA0400XAddiction (Substance Use Disorder) Counselor23492ND

General Provider Information

NPI Number : 1578194742
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY GREEN
Provider Business Mailing Address
First Line : 310 MURPHY DR
Second Line :
City : LEXINGTON
State : NC
Zip : 27295-2100
Country : US
Telephone Number : 336-224-1919
Fax Number :
Provider Business Practice Location Address
First Line : 310 MURPHY DR
Second Line :
City : LEXINGTON
State : NC
Zip : 27295-2100
Country : US
Telephone Number : 336-224-1919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2020
Last Update Date : 01/28/2020

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Directions to “ KELSEY GREEN ” Practice Location

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