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Provider Information for 1174852156


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Dr. SHA-RHONDA M. GREEN PhD, LCSW


Sex: Female

NPI: 1174852156
Last Updated: 2025-02-07
Certification Date: 2025-02-07

Details

NameValue
NPI1174852156
Enumeration Date2009-12-21
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address PO BOX 1311
NORTHPORT, AL 35476-6311
United States

Phone: 678-602-9709 | Fax:
 
Primary Practice Address PO BOX 1311
NORTHPORT, AL 35476-6311
United States

Phone: 336-939-6626 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 1041C0700X - Social Worker - ClinicalGACSW003415
No 1041S0200X - Social Worker - SchoolGA655925
Yes 1041C0700X - Social Worker - ClinicalTX114985