Individual
CHANEL M GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3117 BENNINGER TRCE SW, ATLANTA, GA 30331-6266
(678) 938-7590
Mailing address
3117 BENNINGER TRCE SW, ATLANTA, GA 30331-6266
(678) 938-7590
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
MSW007493
GA
1041C0700X
Clinical Social Worker
Primary
CSW008390
GA
Other
Enumeration date
09/02/2021
Last updated
02/01/2023
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