Provider Demographics
NPI:1841904828
Name:GREEN, LAMONT (COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:LAMONT
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 E COOLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6324
Mailing Address - Country:US
Mailing Address - Phone:909-370-1777
Mailing Address - Fax:909-370-1776
Practice Address - Street 1:2275 E COOLEY DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-6324
Practice Address - Country:US
Practice Address - Phone:909-370-1777
Practice Address - Fax:909-370-1776
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11318101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor