Provider Demographics
NPI:1023649845
Name:GREEN, WILLYNETTE (CSW)
Entity type:Individual
Prefix:
First Name:WILLYNETTE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 ABEND CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346
Mailing Address - Country:US
Mailing Address - Phone:225-993-1130
Mailing Address - Fax:
Practice Address - Street 1:3113 ABEND CHURCH RD
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346
Practice Address - Country:US
Practice Address - Phone:225-993-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16952104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker