Provider Demographics
NPI:1881814093
Name:GREEN, JAMES N JR (BS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:N
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 CLARKS VALLEY RD
Mailing Address - Street 2:BOX 624
Mailing Address - City:SWORDS CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:24649
Mailing Address - Country:US
Mailing Address - Phone:276-963-3554
Mailing Address - Fax:276-964-4802
Practice Address - Street 1:4302 CLARKS VALLEY RD
Practice Address - Street 2:
Practice Address - City:SWORDS CREEK
Practice Address - State:VA
Practice Address - Zip Code:24649
Practice Address - Country:US
Practice Address - Phone:276-991-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VALVN-164X00000X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)