Individual
DIAMONIQUE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6865 PARKDALE PL, INDIANAPOLIS, IN 46254-5654
(317) 299-5437
Mailing address
12045 E HARVEST GLEN DR, INDIANAPOLIS, IN 46229-9705
(317) 401-4048
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
19-84460
IN
Other
Enumeration date
11/01/2021
Last updated
11/01/2021
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