Individual
MICHAEL GEORGE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
350 GRAHAM ST, STRATFORD, CT 06615-5500
(203) 556-4632
Mailing address
350 GRAHAM ST, STRATFORD, CT 06615-5500
(203) 556-4632
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1498
CT
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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