Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0701004328 | VA |
Y | 101YM0800X | Mental Health Counselor | 0701004328 | VA |
N | 101YP1600X | Pastoral Counselor | 0701004328 | VA |
NPI | 1346368636 |
---|---|
Provider Name | Thea A Green |
First Address | Richmond, VA 23225-4101 |
Second Address | Richmond, VA 23225-4101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 19/12/2012 |