Individual
BENITA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5300 MEMORIAL DR STE 121, STONE MOUNTAIN, GA 30083-3154
(404) 254-4500
Mailing address
256 STRICKLAND ST, FAIRBURN, GA 30213-1130
(404) 895-9071
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC015186
GA
101YP2500X
Professional Counselor
005547
GA
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
10/30/2018
Last updated
01/27/2025
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