Individual
JACQUELINE B. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2517 BEMISS RD, SUITE C-1, VALDOSTA, GA 31602-1963
(229) 245-0330
(866) 738-7755
Mailing address
2913 MELROSE DR, VALDOSTA, GA 31602-2069
(229) 245-7009
(866) 738-7755
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
001586
GA
Other
Enumeration date
12/05/2006
Last updated
07/08/2007
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