Provider Demographics
NPI:1245663814
Name:RICHMOND GREEN, KEBA JANINE (LAPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KEBA
Middle Name:JANINE
Last Name:RICHMOND GREEN
Suffix:
Gender:F
Credentials:LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 PEACHTREE RD NE STE 145-1358
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1085
Mailing Address - Country:US
Mailing Address - Phone:404-399-6308
Mailing Address - Fax:
Practice Address - Street 1:3883 ROGERS BRIDGE RD STE 202A
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2803
Practice Address - Country:US
Practice Address - Phone:770-904-9921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8933101Y00000X
GALPC012998101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor