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General NPI Number Information
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NPI Number | 1285189118
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Entity Type | Individual
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Provider Name | DEXTER GREEN MCAP, CCJAP, ICRCADC
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Gender | Male
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Dates
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Enumeration Date | 08/21/2016
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Last Update Date | 08/21/2016
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Provider Practice Location Address
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Address Line | 15485 EAGLE NEST LN SUITE 210
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2247
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Country | US
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Telephone | 973-510-3703
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 CLEVELAND ST
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City | HOLLYWOOD
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State | FL
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Zip | 33020-2930
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Country | US
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Telephone | 973-510-3703
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Fax |
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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 | ADC-010386-2015
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License Number State | FL
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