Provider Demographics
NPI:1457562605
Name:GREEN, ESTHER W (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:W
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14151 LOTUS LN APT 12310
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6378
Mailing Address - Country:US
Mailing Address - Phone:571-246-3249
Mailing Address - Fax:
Practice Address - Street 1:14151 LOTUS LN APT 12310
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-6378
Practice Address - Country:US
Practice Address - Phone:571-246-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004738101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty