Individual
GARY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
474 ALLEN DR, LAWRENCEVILLE, GA 30043-3700
(678) 373-5059
Mailing address
474 ALLEN DR, LAWRENCEVILLE, GA 30043-3700
(678) 373-5059
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
APC005861
GA
101YP2500X
Professional Counselor
Primary
LPC011779
GA
Other
Enumeration date
09/22/2018
Last updated
02/13/2023
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