Organization
C. O. A. C. H. MENTAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWAYNE GREEN LCPC (OWNER)
(443) 506-6313
Entity
Organization
Contact information
Practice address
5 SHAWAN RD STE 101C, HUNT VALLEY, MD 21030-1373
(443) 982-0692
(443) 982-0610
Mailing address
5 SHAWAN RD STE 101C, HUNT VALLEY, MD 21030-1373
(443) 982-0692
(443) 982-0610
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC3757
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH001372
MARYLAND DEPARTMENT OF HEALTH, BEHAVIORAL HEALTH ADMINISTRATION
MD
Enumeration date
02/05/2013
Last updated
02/25/2019
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