Provider Demographics
NPI:1295932143
Name:GREEN, J. ALEX (LCPC,LCADC,NCC,NBCCH)
Entity type:Individual
Prefix:MR
First Name:J. ALEX
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:LCPC,LCADC,NCC,NBCCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:410-808-2786
Mailing Address - Fax:410-715-6984
Practice Address - Street 1:2115 N CHARLES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5760
Practice Address - Country:US
Practice Address - Phone:410-808-2786
Practice Address - Fax:410-715-6984
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2308101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD014003101Medicaid