Provider Demographics
NPI:1447780333
Name:GREEN, SHEMEKA D
Entity Type:Individual
Prefix:MS
First Name:SHEMEKA
Middle Name:D
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRUSLY
Mailing Address - State:LA
Mailing Address - Zip Code:70719-2116
Mailing Address - Country:US
Mailing Address - Phone:225-301-0267
Mailing Address - Fax:
Practice Address - Street 1:203 E OAK ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2817
Practice Address - Country:US
Practice Address - Phone:225-205-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health