Provider Demographics
NPI:1386457117
Name:GREEN, PATTI (LCSWA)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8028 GARNKIRK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2205
Mailing Address - Country:US
Mailing Address - Phone:336-971-8280
Mailing Address - Fax:
Practice Address - Street 1:8025 N POINT BLVD STE 219
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3262
Practice Address - Country:US
Practice Address - Phone:336-355-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0201301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical