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General NPI Number Information
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NPI Number | 1134308828
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Entity Type | Organization
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Legal Business Name | ALEX GREEN & ASSOCIATES
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 5537 TWIN KNOLLS RD SUITE 440
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City | COLUMBIA
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State | MD
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Zip | 21045-3270
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Country | US
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Telephone | 410-715-6983
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Fax | 410-715-6984
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Provider Business Mailing Address
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Address Line | 1700 MERIDENE DR SUITE 611
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City | BALTIMORE
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State | MD
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Zip | 21239-2032
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Country | US
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Telephone | 410-435-1474
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. J. ALEX GREEN
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Credential | LCPC, CAC-AD,CRC
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Telephone | 410-715-6983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LC2308
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License Number State | MD
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