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Individual

MR. MARVIN LEONARD GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CADC

Contact information

Practice address
4259 S BERKELEY AVE, CHICAGO, IL 60653-3030
(312) 337-1073
Mailing address
1276 N CLYBOURN AVE, CHICAGO, IL 60610-2003
(312) 337-1073

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22756
IL

Other

Enumeration date
04/05/2023
Last updated
04/05/2023
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