Active NPI
Rebecca Marie Green, LPC
- Mental Health Counselor
- Winder, GA
National Provider Identifier
1366143174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 013651
- Practice address
- 104 W Candler St
Winder, GA 30680-1733 - Phone
- (770) 246-2822
- Fax
- (770) 966-6995
- NPI assigned
- Mar 17, 2023
- Last updated
- Mar 17, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 013651 | GA | Primary |
Addresses
Primary practice location
104 W Candler St
Winder, GA 30680-1733
Mailing address
142 Summit View Dr.
Jefferson, GA 30549
Phone (404) 642-7613
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 19, 2024 through Jan 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013651 | GA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Abundant Life Institute Inc | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Counselor
- Winder, GA
- NPI 1861985327
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679011200000",
"number": "1366143174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "142 SUMMIT VIEW DR.",
"city": "JEFFERSON",
"state": "GA",
"postal_code": "30549",
"telephone_number": "404-642-7613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 W CANDLER ST",
"city": "WINDER",
"state": "GA",
"postal_code": "306801733",
"telephone_number": "770-246-2822",
"fax_number": "770-966-6995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "REBECCA",
"middle_name": "MARIE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-17",
"last_updated": "2023-03-17",
"certification_date": "2023-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "013651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winder, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.