Individual
CARMANEILA L. GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
67 S DIXIE HWY, ST AUGUSTINE, FL 32084-0317
(904) 429-7573
(904) 547-2731
Mailing address
PO BOX 9113, FLEMING ISLAND, FL 32006-0023
(904) 215-9273
(904) 264-4154
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
000738
FL
101YM0800X
Mental Health Counselor
000738
FL
1041C0700X
Clinical Social Worker
Primary
000738
FL
Other
Enumeration date
04/10/2012
Last updated
09/26/2012
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