Provider Demographics
NPI:1366709420
Name:GREENE, LISA CARTER (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CARTER
Last Name:GREENE
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 1:106 BROWNING PT
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-9534
Mailing Address - Country:US
Mailing Address - Phone:478-714-9318
Mailing Address - Fax:478-333-6531
Practice Address - Street 1:106 BROWNING PT
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-9534
Practice Address - Country:US
Practice Address - Phone:478-714-9318
Practice Address - Fax:478-475-9492
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional