Provider Demographics
NPI:1053904292
Name:GREEN, ANGEL FAITH
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:FAITH
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18318 3RD AVE NE # NA
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-3542
Mailing Address - Country:US
Mailing Address - Phone:425-309-9358
Mailing Address - Fax:
Practice Address - Street 1:6021 244TH ST SW STE 400
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5426
Practice Address - Country:US
Practice Address - Phone:425-245-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician