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General NPI Number Information
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NPI Number | 1043959919
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Entity Type | Individual
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Provider Name | JAMI A GREEN LSW, LCDC III, SWA
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Gender | Female
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 149 MERCY BLVD
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City | MOUNT ORAB
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State | OH
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Zip | 45154-0296
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Country | US
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Telephone | 937-712-3121
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Fax | 937-712-3122
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Provider Business Mailing Address
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Address Line | 149 MERCY BLVD
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City | MOUNT ORAB
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State | OH
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Zip | 45154-0296
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Country | US
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Telephone | 937-712-3121
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Fax | 937-712-3122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LICDC.162696
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 259591
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2411371
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License Number State | OH
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