Provider Demographics
NPI:1871922146
Name:GREEN FOOTE, TAMEKA (LPC)
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:GREEN FOOTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 STACY PL
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2144
Mailing Address - Country:US
Mailing Address - Phone:973-418-3191
Mailing Address - Fax:
Practice Address - Street 1:12 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3211
Practice Address - Country:US
Practice Address - Phone:973-418-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00472100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional