Individual
INGRID C GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
25 MAIN ST, SPARTA, NJ 07871-1937
(973) 865-4545
Mailing address
310 PARKWAY DR, CLARK, NJ 07066-1626
(738) 654-5459
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37AC00455500
NJ
Other
Enumeration date
02/24/2020
Last updated
02/24/2020
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