Provider Demographics
NPI:1033807623
Name:GREENE, YASHMAN SHAUNTIA (AMFT)
Entity Type:Individual
Prefix:
First Name:YASHMAN
Middle Name:SHAUNTIA
Last Name:GREENE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 NOBLE CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-5135
Mailing Address - Country:US
Mailing Address - Phone:336-354-8752
Mailing Address - Fax:
Practice Address - Street 1:707 WHITLOCK AVE SW STE H10
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3098
Practice Address - Country:US
Practice Address - Phone:470-298-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist