Provider Demographics
NPI:1043959919
Name:GREEN, JAMI A (LSW, LCDC III, SWA)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:A
Last Name:GREEN
Suffix:
Gender:F
Credentials:LSW, LCDC III, SWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MERCY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-0296
Mailing Address - Country:US
Mailing Address - Phone:937-712-3121
Mailing Address - Fax:937-712-3122
Practice Address - Street 1:149 MERCY BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-0296
Practice Address - Country:US
Practice Address - Phone:937-712-3121
Practice Address - Fax:937-712-3122
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162696101YA0400X
KY259591104100000X
OHS.2411371104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)