Provider Demographics
NPI:1841557998
Name:GREEN, AARON B (LICDC)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:B
Last Name:GREEN
Suffix:
Gender:M
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1927
Mailing Address - Country:US
Mailing Address - Phone:330-722-4325
Mailing Address - Fax:800-886-4089
Practice Address - Street 1:133 N COURT ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1927
Practice Address - Country:US
Practice Address - Phone:330-722-4325
Practice Address - Fax:800-886-4089
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965679101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)