Provider Demographics
NPI:1407403389
Name:GREEN, SOPHIA H (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:H
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-0013
Mailing Address - Country:US
Mailing Address - Phone:206-940-9312
Mailing Address - Fax:
Practice Address - Street 1:360 GRAND AVE # 46
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4840
Practice Address - Country:US
Practice Address - Phone:206-940-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health