Individual
DEXTER GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MCAP, CCJAP, ICRCADC
Contact information
Practice address
15485 EAGLE NEST LN, SUITE 210, MIAMI LAKES, FL 33014-2247
(973) 510-3703
Mailing address
2901 CLEVELAND ST, HOLLYWOOD, FL 33020-2930
(973) 510-3703
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ADC-010386-2015
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
803591
ICRC-ADC
FL
01
—
ADC-005091-2014
CCJAP
FL
01
—
ADC-010386-2015
MCAP
FL
Enumeration date
08/21/2016
Last updated
08/21/2016
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