Provider Demographics
NPI:1477573525
Name:GREEN, IOLA SHELIA (MSSW,LMSW,CCJS)
Entity Type:Individual
Prefix:MS
First Name:IOLA
Middle Name:SHELIA
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSSW,LMSW,CCJS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FOX CHASE LN APT 6
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071-5422
Mailing Address - Country:US
Mailing Address - Phone:859-781-6095
Mailing Address - Fax:859-572-6222
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:859-572-6222
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010827681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical