Provider Demographics
NPI:1902825995
Name:GREEN, HEIDI LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LOUISE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4020 CAPITAL BLVD STE 102
Mailing Address - Street 2:CAROLINA COMMUNITY MENTAL HEALTH CENTERS
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3474
Mailing Address - Country:US
Mailing Address - Phone:919-875-3211
Mailing Address - Fax:919-875-4122
Practice Address - Street 1:4020 CAPITAL BLVD STE 102
Practice Address - Street 2:CAROLINA COMMUNITY MENTAL HEALTH CENTERS
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3474
Practice Address - Country:US
Practice Address - Phone:919-875-3211
Practice Address - Fax:919-875-4122
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2003007962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2018243AOtherMEDICARE
477015OtherHUMANA GOLD CHOICE
NC134VCOtherBCBS
NC89134VCMedicaid
477015OtherHUMANA GOLD CHOICE