Provider Demographics
NPI:1043466006
Name:GREEN, TERESA (LGPC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10208 BUCKMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2925
Mailing Address - Country:US
Mailing Address - Phone:301-528-9973
Mailing Address - Fax:
Practice Address - Street 1:10208 BUCKMEADOW LN
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2925
Practice Address - Country:US
Practice Address - Phone:301-528-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health