Provider Demographics
NPI:1548476039
Name:GREEN, FRANK PAUL (MFT)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:PAUL
Last Name:GREEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 FALL BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8719
Mailing Address - Country:US
Mailing Address - Phone:919-244-8213
Mailing Address - Fax:
Practice Address - Street 1:7716 FALL BRANCH CT
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8719
Practice Address - Country:US
Practice Address - Phone:919-244-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC488OtherNORTH CAROLINA MFT