Provider Demographics
NPI:1144019167
Name:GREEN, JENNIFER DIANE MILLER (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE MILLER
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 PATRIOT PL
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9333
Mailing Address - Country:US
Mailing Address - Phone:828-455-2790
Mailing Address - Fax:
Practice Address - Street 1:404 PATRIOT PL
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9333
Practice Address - Country:US
Practice Address - Phone:828-455-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6722103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical