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Individual

IYANA SARAH - ANTWANETTE GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
5121 KINGDOM WAY STE 10, RALEIGH, NC 27607-6062
(919) 559-1316
Mailing address
5121 KINGDOM WAY STE 10, RALEIGH, NC 27607-6062
(919) 559-1316

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary

Other

Enumeration date
05/26/2025
Last updated
05/26/2025
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