Healthcare Provider Details

I. General information

NPI: 1093506438
Provider Name (Legal Business Name): ANGELA D GREENE CHW, CPRS, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E BROAD ST
COLUMBUS OH
43213-1140
US

IV. Provider business mailing address

815 W BROAD ST STE 200
COLUMBUS OH
43222-1465
US

V. Phone/Fax

Practice location:
  • Phone: 614-778-3367
  • Fax:
Mailing address:
  • Phone: 614-717-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195290
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: