Individual
LEMARRICK GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHT
Contact information
Practice address
365 W REED RD STE A-1, GREENVILLE, MS 38701-6967
(662) 702-5108
Mailing address
365 W REED RD STE A-1, GREENVILLE, MS 38701-6967
(662) 702-5108
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396196879
—
MS
Enumeration date
10/09/2017
Last updated
10/09/2017
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