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Organization
INSPIRED BY CHANGE
Active
Organization
INSPIRED BY CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN FENDELL GREEN PH.D, LCSW, LCASA (OWNER)
(910) 835-6895
Entity
Organization
Contact information
Practice address
6490 KELMSCOT CT, FAYETTEVILLE, NC 28303-5674
(910) 835-6895
Mailing address
2754 SHELLBARK RD # A, DECATUR, GA 30035-4113
(910) 475-8048
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
11/12/2024
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