Individual
NIA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
2601 N WALTON BLVD STE 1, BENTONVILLE, AR 72712-4302
(479) 802-4798
(479) 668-0589
Mailing address
2601 N WALTON BLVD STE 1, BENTONVILLE, AR 72712-4302
(479) 802-4798
(479) 668-0589
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
20-120556
AR
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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