Individual
DEREN ROBERT GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1401 DEZARAE LOT #3, SAN ANTONIO, TX 78253
(210) 875-1437
Mailing address
1401 DEZARAE LOT #3, SAN ANTONIO, TX 78253
(210) 875-1437
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12145
TX
Other
Enumeration date
09/11/2019
Last updated
09/11/2019
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