Provider Demographics
NPI:1811004278
Name:GREEN, FAYE (MS LAC CCGC CCS)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS LAC CCGC CCS
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:
Other - Last Name:GREEN-HOBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:210 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6052
Mailing Address - Country:US
Mailing Address - Phone:318-357-3122
Mailing Address - Fax:318-357-3240
Practice Address - Street 1:210 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457
Practice Address - Country:US
Practice Address - Phone:318-357-3122
Practice Address - Fax:318-357-3240
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106101YA0400X
171M00000X
LA863101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator