Individual
THEA A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1351 BLACKROCK DR, RICHMOND, VA 23225-4101
(804) 882-6163
Mailing address
1351 BLACKROCK DR, RICHMOND, VA 23225-4101
(804) 882-6163
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0701004328
VA
101YM0800X
Mental Health Counselor
Primary
0701004328
VA
101YP1600X
Pastoral Counselor
0701004328
VA
Other
Enumeration date
03/26/2007
Last updated
12/19/2012
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