Provider Demographics
NPI:1770607954
Name:GREEN, CHRISTINA MICHELLE (MA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MICHELLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 INDIAN RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1538
Mailing Address - Country:US
Mailing Address - Phone:567-318-4447
Mailing Address - Fax:
Practice Address - Street 1:122 W FRONT ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1467
Practice Address - Country:US
Practice Address - Phone:567-318-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.081118101YA0400X
OH162228101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)