Provider Demographics
NPI:1811603798
Name:GREEN, CARNEKA
Entity type:Individual
Prefix:MS
First Name:CARNEKA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 KINGSMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9204
Mailing Address - Country:US
Mailing Address - Phone:330-371-6698
Mailing Address - Fax:
Practice Address - Street 1:257 KINGSMEADOW LN
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9204
Practice Address - Country:US
Practice Address - Phone:330-371-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006522175T00000X
251B00000X, 251V00000X, 374J00000X, 175T00000X
OH251S00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer Specialist
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No347C00000XTransportation ServicesPrivate Vehicle
No374J00000XNursing Service Related ProvidersDoula