Provider Demographics
NPI:1891178364
Name:GREEN, STEVEN WILLIAM (LMBT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:WILLIAM
Last Name:GREEN
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2501
Mailing Address - Country:US
Mailing Address - Phone:803-603-9289
Mailing Address - Fax:
Practice Address - Street 1:185 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2501
Practice Address - Country:US
Practice Address - Phone:803-603-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14498174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist