Individual
MRS. NATASHA R. GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1745 KEVIN LN, LAKE CHARLES, LA 70605-7111
(337) 802-3391
Mailing address
1745 KEVIN LN, LAKE CHARLES, LA 70605-7111
(337) 802-3391
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4168
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005775710
DRIVER'S LICENSE
LA
Enumeration date
01/25/2022
Last updated
01/25/2022
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