Provider Demographics
NPI:1932229044
Name:GREEN, JANE STEWART (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:STEWART
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 CARDOVA DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4208
Mailing Address - Country:US
Mailing Address - Phone:404-808-5186
Mailing Address - Fax:
Practice Address - Street 1:2150 PEACHFORD RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6520
Practice Address - Country:US
Practice Address - Phone:404-808-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist