Organization
KESHA GREEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KESHA PANIKA GREEN LMSW (OWNER/CLINICIAN)
(706) 332-0526
Entity
Organization
Contact information
Practice address
122 GREYSTONE CIR, HIRAM, GA 30141-3141
(706) 332-0526
Mailing address
122 GREYSTONE CIR, HIRAM, GA 30141-3141
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
GA
Other
Enumeration date
02/06/2012
Last updated
02/06/2012
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