Provider Demographics
NPI:1689061301
Name:GREEN, JAYNE' (LPC, CAMS II, CFMHE)
Entity Type:Individual
Prefix:
First Name:JAYNE'
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC, CAMS II, CFMHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 BISHOP ST NW APT 424
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4537
Mailing Address - Country:US
Mailing Address - Phone:404-519-0080
Mailing Address - Fax:
Practice Address - Street 1:5887 GLENRIDGE DR
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5574
Practice Address - Country:US
Practice Address - Phone:404-519-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health