Provider Demographics
NPI:1447641782
Name:GREEN, JESSICA MICHELLE (LPC ATR-BC, CTT, BSL)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC ATR-BC, CTT, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 SANTA BARBARA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4106
Mailing Address - Country:US
Mailing Address - Phone:717-936-9758
Mailing Address - Fax:717-618-6730
Practice Address - Street 1:1891 SANTA BARBARA DR STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4106
Practice Address - Country:US
Practice Address - Phone:717-936-9758
Practice Address - Fax:717-618-6730
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001296101YM0800X
PAPC008159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health