Provider Demographics
NPI:1922143221
Name:GREEN, VICKIE LYNN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:LYNN
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10356 OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-8924
Mailing Address - Country:US
Mailing Address - Phone:989-344-1269
Mailing Address - Fax:989-344-1269
Practice Address - Street 1:10356 OAKDALE DR
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-8924
Practice Address - Country:US
Practice Address - Phone:989-344-1269
Practice Address - Fax:989-344-1269
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional