| Doctor Name: | MRS. NICOLE GREEN |
| NPI Number: | 1861812091 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | LC4253 |
| Business Practice Address: | 6707 Whitestone Rd 106 Woodlawn, MD - 212074106 |
| Business Phone Number: | 4102658737 |
| Business Fax Number: | 4102651258 |
| Mailing Address: | 6707 Whitestone Rd, 106 WOODLAWN |
| State: | MD |
| Postal Code: | 212074106 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/28/2014 |
| NPI Last Update Date: | 04/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LC4253 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |