Individual
DOMINIC GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4728 QUADRANT ST, CAPITOL HEIGHTS, MD 20743-5266
(240) 781-9659
Mailing address
4728 QUADRANT ST, CAPITOL HEIGHTS, MD 20743-5266
(240) 781-9659
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/08/2023
Last updated
04/17/2023
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