Provider Demographics
NPI:1881050771
Name:GREEN, U'DANA LYNELL (MA, CI 5108)
Entity type:Individual
Prefix:MS
First Name:U'DANA
Middle Name:LYNELL
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, CI 5108
Other - Prefix:MS
Other - First Name:U'DANA
Other - Middle Name:LYNELL
Other - Last Name:GREEN
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MA, CI 5108
Mailing Address - Street 1:5555 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-1806
Mailing Address - Country:US
Mailing Address - Phone:225-341-3568
Mailing Address - Fax:225-341-3569
Practice Address - Street 1:5555 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-1806
Practice Address - Country:US
Practice Address - Phone:225-341-3568
Practice Address - Fax:225-341-3569
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health