Individual
ICICESS GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2407 PLANTATION CENTER DR STE 100, MATTHEWS, NC 28105-5418
(704) 448-9819
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
NC
106S00000X
Behavior Technician
RBT-22-230400
MS
Other
Enumeration date
08/19/2022
Last updated
04/16/2026
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