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General NPI Number Information
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NPI Number | 1982740056
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Entity Type | Organization
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Legal Business Name | GREEN DOOR, INC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1221 TAYLOR ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-5617
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Country | US
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Telephone | 202-464-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 TAYLOR ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-5617
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Country | US
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Telephone | 202-464-9200
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Fax |
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Authorized Official
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Title or Position | DEPUTY DIRECTOR
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Name | MR. MICHAEL CLANCY
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Credential |
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Telephone | 202-464-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC302086
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License Number State | DC
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