Provider Demographics
NPI:1861025645
Name:HAMMONDS-GREENE, PATTI JO (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:PATTI
Middle Name:JO
Last Name:HAMMONDS-GREENE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11514 SUMMER TRCE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2694
Mailing Address - Country:US
Mailing Address - Phone:770-490-7190
Mailing Address - Fax:
Practice Address - Street 1:11514 SUMMER TRCE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2694
Practice Address - Country:US
Practice Address - Phone:770-490-7190
Practice Address - Fax:678-817-4344
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical