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NPI Code Detail

MEDICARE: SUSAN GAIL GREEN M.A.

MEDICARE: SUSAN GAIL GREEN M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1831311265
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN GAIL GREEN M.A.
Provider Business Mailing Address
First Line : 4192 ROCK RIVER RD
Second Line :
City : ROCK
State : WV
Zip : 24747-9739
Country : US
Telephone Number : 304-589-3761
Fax Number :
Provider Business Practice Location Address
First Line : 111 TOWN HOLLOW RD
Second Line :
City : CEDAR BLUFF
State : VA
Zip : 24609-9622
Country : US
Telephone Number : 276-963-3554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 07/08/2007

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Directions to “ SUSAN GAIL GREEN M.A.” Practice Location

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