Provider Demographics
NPI:1689061301
Name:GREEN, JAYNE' (LPC, LMHC, CAMS II)
Entity type:Individual
Prefix:
First Name:JAYNE'
Middle Name:
Last Name:GREEN
Suffix:
Gender:
Credentials:LPC, LMHC, CAMS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 GARDENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GRANT VALKARIA
Mailing Address - State:FL
Mailing Address - Zip Code:32949-8244
Mailing Address - Country:US
Mailing Address - Phone:407-271-2039
Mailing Address - Fax:
Practice Address - Street 1:5887 GLENRIDGE DR
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5574
Practice Address - Country:US
Practice Address - Phone:404-519-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010885101YP2500X
FLMH24864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional