Provider Demographics
NPI:1114300647
Name:GREEN, JULIAN (LCSW, LISW)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ORCHARD PARK DR UNIT 26141
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-5051
Mailing Address - Country:US
Mailing Address - Phone:864-313-7047
Mailing Address - Fax:
Practice Address - Street 1:1 CHICK SPRINGS RD STE 313D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4972
Practice Address - Country:US
Practice Address - Phone:864-313-7047
Practice Address - Fax:864-670-8029
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00016391041C0700X
SC102541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical