Provider Demographics
NPI:1932675246
Name:GREEN, MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 EMERALD PL STE 104
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5739
Mailing Address - Country:US
Mailing Address - Phone:252-665-1503
Mailing Address - Fax:252-364-3451
Practice Address - Street 1:2459 EMERALD PL STE 104
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5739
Practice Address - Country:US
Practice Address - Phone:252-665-1503
Practice Address - Fax:252-364-3451
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0182891041C0700X
NCP0175421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical