Individual
LARESA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4317 11TH ST, ECORSE, MI 48229-1162
(313) 520-5311
Mailing address
4317 11TH ST, ECORSE, MI 48229-1162
(313) 520-5311
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Enumeration date
06/20/2024
Last updated
06/20/2024
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