Provider Demographics
NPI:1891977633
Name:GREEN, EMILY (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:LYNN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, EDS, LPC
Mailing Address - Street 1:215 FAYETTEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030
Mailing Address - Country:US
Mailing Address - Phone:678-561-0835
Mailing Address - Fax:
Practice Address - Street 1:1145 SHERIDAN RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3714
Practice Address - Country:US
Practice Address - Phone:678-561-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional