Provider Demographics
NPI:1669113825
Name:GREEN, CHERYL DENISE (LLMSW)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:DENISE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23450 BEVERLY ST # 523-9102
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1971
Mailing Address - Country:US
Mailing Address - Phone:313-523-9102
Mailing Address - Fax:
Practice Address - Street 1:26520 GRAND RIVER AVE STE 121
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1506
Practice Address - Country:US
Practice Address - Phone:313-533-5652
Practice Address - Fax:313-533-5644
Is Sole Proprietor?:No
Enumeration Date:2022-04-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511090981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical