Provider Demographics
NPI:1639391923
Name:GREEN, BRENDA MILLER (MS)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MILLER
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W GUILFORD ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-3945
Mailing Address - Country:US
Mailing Address - Phone:336-472-4459
Mailing Address - Fax:336-472-0073
Practice Address - Street 1:25 W GUILFORD ST
Practice Address - Street 2:SUITE 11
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3945
Practice Address - Country:US
Practice Address - Phone:336-472-4459
Practice Address - Fax:336-472-0073
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC595101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)