Healthcare Provider Details

I. General information

NPI: 1295932143
Provider Name (Legal Business Name): J. ALEX GREEN LCPC,LCADC,NCC,NBCCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 05/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 N CHARLES ST SUITE 200
BALTIMORE MD
21218-5760
US

IV. Provider business mailing address

1700 MERIDENE DR SUITE 611
BALTIMORE MD
21239-2032
US

V. Phone/Fax

Practice location:
  • Phone: 410-808-2786
  • Fax: 410-715-6984
Mailing address:
  • Phone: 410-808-2786
  • Fax: 410-715-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC2308
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2308
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: