Individual
SHANICKA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 WESTRIDGE RD, CARLSBAD, NM 88220-3550
(575) 725-5552
Mailing address
PO BOX 3141, CARLSBAD, NM 88221-3141
(575) 725-5552
(575) 725-5552
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CTB20250457
NM
172V00000X
Community Health Worker
—
NM
175T00000X
Peer Specialist
1735
NM
Other
Enumeration date
07/18/2024
Last updated
09/19/2025
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