Provider Demographics
NPI:1770694077
Name:GREEN, VIKKI LOUISE (LPC)
Entity type:Individual
Prefix:MS
First Name:VIKKI
Middle Name:LOUISE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20601 VAN ANTWERP ST
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1403
Mailing Address - Country:US
Mailing Address - Phone:248-633-6584
Mailing Address - Fax:313-640-9211
Practice Address - Street 1:20601 VAN ANTWERP ST
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1403
Practice Address - Country:US
Practice Address - Phone:248-633-6584
Practice Address - Fax:313-640-9211
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401008028OtherSTATE LICENSE