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General NPI Number Information
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NPI Number | 1023719010
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Entity Type | Organization
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Legal Business Name | GREEN HOLISTIC RECOVERY, LLC
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 4520 WICHERS DR STE 202
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City | MARRERO
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State | LA
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Zip | 70072-3135
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Country | US
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Telephone | 504-606-9316
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Fax | 504-383-0937
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Provider Business Mailing Address
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Address Line | 4520 WICHERS DRIVE SUITE 202
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City | MARRERO
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State | LA
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Zip | 70072
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Country | US
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Telephone | 504-606-9316
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Fax | 504-383-0937
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. DWANA JOHNSON GREEN
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Credential | SCD
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Telephone | 504-606-9316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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Taxonomy #3
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number |
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Taxonomy #5
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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Taxonomy #7
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number |
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Taxonomy #9
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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Taxonomy #10
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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