Individual
SHONTANAE IMANI GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC, NCC
Contact information
Practice address
247 SASSAFRAS LN, GROVETOWN, GA 30813-7300
(706) 631-1882
Mailing address
247 SASSAFRAS LN, GROVETOWN, GA 30813-7300
(706) 631-1882
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC014138
GA
Other
Enumeration date
11/11/2021
Last updated
09/19/2023
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