Provider Demographics
NPI:1366143174
Name:GREEN, REBECCA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SUMMIT VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549
Mailing Address - Country:US
Mailing Address - Phone:404-642-7613
Mailing Address - Fax:
Practice Address - Street 1:104 W CANDLER ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1733
Practice Address - Country:US
Practice Address - Phone:770-246-2822
Practice Address - Fax:770-966-6995
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health