| Doctor Name: | MR. WADE M GREEN |
| NPI Number: | 1033221676 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, NCC, LCPC |
| License Number: | LC2196 |
| Business Practice Address: | 6100 Radio Station Rd. La Plata, MD - 20646 |
| Business Phone Number: | 3016099887 |
| Business Fax Number: | |
| Mailing Address: | 4665 Prestancia Pl Apt 303, WALDORF |
| State: | MD |
| Postal Code: | 206024131 |
| Phone Number: | 3019286045 |
| Fax Number: | 3013920306 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 06/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LC2196 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |