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1790909695
PHYLLIS LOUISE GREEN
STOCKTON, CA
NPI
1790909695
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2007-04-12
Last Update Date
2007-07-08
Business Address
-- PHYLLIS LOUISE GREEN
8026 LORRAINE AVE SUITE 201
STOCKTON, CA 95210-4224
Phone number: 209-644-6328
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Mailing Address
-- PHYLLIS LOUISE GREEN
4230 GISELLE LN
STOCKTON, CA 95206-6509
Phone number: 209-513-0247
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