Provider Demographics
NPI:1689149817
Name:GREEN, DESTINY JOY (LCSW)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:JOY
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 HIGHWAY 6 N STE 311
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1857
Mailing Address - Country:US
Mailing Address - Phone:832-280-4054
Mailing Address - Fax:832-280-9919
Practice Address - Street 1:5870 HIGHWAY 6 N STE 311
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-1857
Practice Address - Country:US
Practice Address - Phone:832-280-4054
Practice Address - Fax:832-280-9919
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty