Provider Demographics
NPI:1326825357
Name:GREEN, HELENA VICTORIA (MA, DIPLMO)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:VICTORIA
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, DIPLMO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14710 NE 396TH ST
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:WA
Mailing Address - Zip Code:98601-3119
Mailing Address - Country:US
Mailing Address - Phone:360-241-5617
Mailing Address - Fax:
Practice Address - Street 1:14710 NE 396TH ST
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:WA
Practice Address - Zip Code:98601-3119
Practice Address - Country:US
Practice Address - Phone:360-241-5617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00093107103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling