Individual
MR. RANDY DALE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAC
Contact information
Practice address
1101 W 3RD ST, FORDYCE, AR 71742-3014
(870) 352-5122
(870) 352-5127
Mailing address
1101 W 3RD ST, FORDYCE, AR 71742-3014
(870) 352-5122
(870) 352-5127
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P1109064
AR
Other
Enumeration date
07/15/2009
Last updated
03/25/2021
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