Provider Demographics
NPI:1093230039
Name:GREEN, ALBERTINA LATRICE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ALBERTINA
Middle Name:LATRICE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 FM 2252 STE 16
Mailing Address - Street 2:
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2578
Mailing Address - Country:US
Mailing Address - Phone:210-413-6868
Mailing Address - Fax:210-281-5108
Practice Address - Street 1:19115 FM 2252 STE 16
Practice Address - Street 2:
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2578
Practice Address - Country:US
Practice Address - Phone:210-413-6868
Practice Address - Fax:210-281-5108
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty