Provider Demographics
NPI:1184096117
Name:GREEN, MCKENZIE (LPC-S)
Entity type:Individual
Prefix:DR
First Name:MCKENZIE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 NEABSCO COMMON PL APT 211
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6701
Mailing Address - Country:US
Mailing Address - Phone:843-855-1526
Mailing Address - Fax:
Practice Address - Street 1:5820 DIX ST. NE
Practice Address - Street 2:BLDG 1 STE 125
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2001
Practice Address - Country:US
Practice Address - Phone:240-736-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC15115101YA0400X, 101YP2500X
NCA9048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty