Provider Demographics
NPI:1295542496
Name:GREEN, ELIZABETH NOEL (LMSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NOEL
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3709
Mailing Address - Country:US
Mailing Address - Phone:865-803-7692
Mailing Address - Fax:
Practice Address - Street 1:1435 HAW CREEK CIR STE 403
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6567
Practice Address - Country:US
Practice Address - Phone:770-940-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW012037104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker