Provider Demographics
NPI:1881969632
Name:GREEN, ANGEL (MS, MA, NCC, LPCA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, MA, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 EXECUTIVE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8859
Mailing Address - Country:US
Mailing Address - Phone:704-227-0669
Mailing Address - Fax:704-227-0690
Practice Address - Street 1:5800 EXECUTIVE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8859
Practice Address - Country:US
Practice Address - Phone:704-227-0669
Practice Address - Fax:704-227-0690
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health