Provider Demographics
NPI:1659898625
Name:GREEN, AMBER MILLICENT DIAMOND (MA, LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MILLICENT DIAMOND
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, LCMHC, NCC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MILLICENT
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:511 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-8423
Mailing Address - Country:US
Mailing Address - Phone:217-891-6186
Mailing Address - Fax:
Practice Address - Street 1:110 IOWA LN STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-2400
Practice Address - Country:US
Practice Address - Phone:919-587-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty