Individual
MS. MAXINE CECILIA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1634 LONDON BLVD, PORTSMOUTH, VA 23704-2137
(757) 393-7200
Mailing address
1634 LONDON BLVD, PORTSMOUTH, VA 23704-2137
(757) 393-7200
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0904007774
VA
Other
Enumeration date
06/18/2012
Last updated
06/18/2012
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