Provider Demographics
NPI:1194387696
Name:GREEN, EVON STRICKLAND (BILLER)
Entity Type:Individual
Prefix:
First Name:EVON
Middle Name:STRICKLAND
Last Name:GREEN
Suffix:
Gender:F
Credentials:BILLER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TIMBERLAKE
Mailing Address - State:NC
Mailing Address - Zip Code:27583-8676
Mailing Address - Country:US
Mailing Address - Phone:336-504-3745
Mailing Address - Fax:
Practice Address - Street 1:201 LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:TIMBERLAKE
Practice Address - State:NC
Practice Address - Zip Code:27583-8676
Practice Address - Country:US
Practice Address - Phone:336-504-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician