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General NPI Number Information
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NPI Number | 1417514654
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Entity Type | Organization
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Legal Business Name | GREEN ACRES COUNSELING AND GROUP SERVICES LLC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 3100 E 45TH ST STE 212C
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City | CLEVELAND
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State | OH
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Zip | 44127-1093
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Country | US
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Telephone | 216-438-2846
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Fax |
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Provider Business Mailing Address
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Address Line | 2283 E 100TH ST
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City | CLEVELAND
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State | OH
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Zip | 44106-3501
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Country | US
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Telephone | 216-633-8644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROLYN GREEN
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Credential | LIDCD.161732
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Telephone | 216-633-8644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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