Individual
EBONY GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2002 GUS KAPLAN DR, ALEXANDRIA, LA 71301
(318) 709-6053
Mailing address
PO BOX 401, POLLOCK, LA 71467-0401
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9300
LA
101YP2500X
Professional Counselor
9300
LA
Other
Enumeration date
10/20/2015
Last updated
01/06/2025
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