Doctor Name: | MS. MAXINE CECILIA GREEN |
NPI Number: | 1013270933 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 0904007774 |
Business Practice Address: | 1634 London Blvd Portsmouth, VA - 237042137 |
Business Phone Number: | 7573937200 |
Business Fax Number: | |
Mailing Address: | 1634 London Blvd, PORTSMOUTH |
State: | VA |
Postal Code: | 237042137 |
Phone Number: | 7573937200 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2012 |
NPI Last Update Date: | 06/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0904007774 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |