Provider Demographics
NPI:1558012765
Name:GREEN, AURENA RACHELLE (RESIDENT COUNSELOR)
Entity Type:Individual
Prefix:
First Name:AURENA
Middle Name:RACHELLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:RESIDENT COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 S VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2967
Mailing Address - Country:US
Mailing Address - Phone:571-218-6717
Mailing Address - Fax:
Practice Address - Street 1:4023 CHAIN BRIDGE RD STE 7
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4121
Practice Address - Country:US
Practice Address - Phone:571-218-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health