Provider Demographics
NPI:1134325103
Name:GREEN, FREIDA LOUISE (MA, LPC, LCAS, NCC)
Entity Type:Individual
Prefix:MS
First Name:FREIDA
Middle Name:LOUISE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, LPC, LCAS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 GLENROCK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-6005
Mailing Address - Country:US
Mailing Address - Phone:910-705-0631
Mailing Address - Fax:
Practice Address - Street 1:5602 GLENROCK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-6005
Practice Address - Country:US
Practice Address - Phone:910-705-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4421101YM0800X
NC72715101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140JUOtherBLUE CROSS BLUE SHIELD
NC6102788Medicaid