Organization
GREEN DOOR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CLANCY (DEPUTY DIRECTOR)
(202) 464-9200
Entity
Organization
Contact information
Practice address
1221 TAYLOR ST NW, WASHINGTON, DC 20011-5617
(202) 464-9200
(202) 464-5730
Mailing address
1221 TAYLOR ST NW, WASHINGTON, DC 20011-5617
(202) 464-9200
(202) 464-5730
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ADD13912
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23349
CHARTERED HEALTH PLAN (MC
DC
01
—
287814
AMERIGROUP (MEDICAID MCO)
DC
01
—
5237
HEALTHRIGHT (MCO)
DC
Enumeration date
01/29/2007
Last updated
08/22/2020
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