Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003134354 |
---|---|
Provider Name | Mr. Maurice Lydell Green SR. |
First Address | Oakland, CA 94605-4023 |
Second Address | San Francisco, CA 94116-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2010 |
Last Update Date | 12/05/2010 |