Provider Demographics
NPI:1134308828
Name:ALEX GREEN & ASSOCIATES
Entity Type:Organization
Organization Name:ALEX GREEN & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CAC-AD,CRC
Authorized Official - Phone:410-715-6983
Mailing Address - Street 1:1700 MERIDENE DR
Mailing Address - Street 2:SUITE 611
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2032
Mailing Address - Country:US
Mailing Address - Phone:410-435-1474
Mailing Address - Fax:
Practice Address - Street 1:5537 TWIN KNOLLS RD
Practice Address - Street 2:SUITE 440
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3270
Practice Address - Country:US
Practice Address - Phone:410-715-6983
Practice Address - Fax:410-715-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2308251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health