Provider Demographics
NPI:1659975357
Name:GREEN, TURQUOISIA (MED)
Entity Type:Individual
Prefix:
First Name:TURQUOISIA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 FORT BRAGG RD # 122
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7037
Mailing Address - Country:US
Mailing Address - Phone:910-758-8778
Mailing Address - Fax:
Practice Address - Street 1:2018 FORT BRAGG RD # 122
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7037
Practice Address - Country:US
Practice Address - Phone:910-758-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health