Provider Demographics
NPI:1821300468
Name:GREEN, EDITH MARIE (LPC)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:MARIE
Other - Last Name:KABIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4125 CLIFTON PARK CIR W APT 108
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-1164
Mailing Address - Country:US
Mailing Address - Phone:614-975-8979
Mailing Address - Fax:
Practice Address - Street 1:4125 CLIFTON PARK CIR W APT 108
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-1164
Practice Address - Country:US
Practice Address - Phone:614-975-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404111101YM0800X, 101YP2500X
NJ37PC00469000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health