Organization
ILLUMINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WADE MORGAN GREEN JR. PSYD., LCPC-S (PARTNER)
(301) 928-6045
Entity
Organization
Contact information
Practice address
605 POST OFFICE RD STE 301, WALDORF, MD 20602-1913
(301) 928-6045
Mailing address
605 POST OFFICE RD STE 301, WALDORF, MD 20602-1913
(301) 928-6045
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC2196
MD
Other
Enumeration date
03/19/2016
Last updated
03/19/2016
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