Provider Demographics
NPI:1700220290
Name:GREEN, DEATRICE MONIQUE (MHS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:DEATRICE
Middle Name:MONIQUE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MHS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 LIGUSTRUM DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-2026
Mailing Address - Country:US
Mailing Address - Phone:504-459-9701
Mailing Address - Fax:
Practice Address - Street 1:7600 LIGUSTRUM DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-2026
Practice Address - Country:US
Practice Address - Phone:504-459-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional