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Individual

AUTUMN GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1822 E NC HIGHWAY 54, DURHAM, NC 27713-3210
(919) 474-6400
Mailing address
6631 ROCKGLEN WAY APT 304, RALEIGH, NC 27615-5690
(919) 827-7241

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
07/26/2021
Last updated
07/26/2021
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