Individual
CANDACE LAVERN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RESIDENT
Contact information
Practice address
291 INDEPENDENCE BLVD BLDG 4, VA BEACH, VA 23462-5481
(757) 593-9971
Mailing address
16 CENTRE PORT CIR, PORTSMOUTH, VA 23703-5453
(757) 593-9971
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704016556
VA
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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