Provider Demographics
NPI:1285427989
Name:GREEN, IYANA SARAH - ANTWANETTE
Entity type:Individual
Prefix:
First Name:IYANA
Middle Name:SARAH - ANTWANETTE
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 KINGDOM WAY STE 10
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6062
Mailing Address - Country:US
Mailing Address - Phone:919-559-1316
Mailing Address - Fax:
Practice Address - Street 1:5121 KINGDOM WAY STE 10
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6062
Practice Address - Country:US
Practice Address - Phone:919-559-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician