Provider Demographics
NPI:1306105424
Name:GREEN, NICOLE TRENE (LPCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TRENE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 TRANQUIL MEADOWS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7302
Mailing Address - Country:US
Mailing Address - Phone:505-903-0387
Mailing Address - Fax:844-714-2499
Practice Address - Street 1:3816 TRANQUIL MEADOWS DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-7302
Practice Address - Country:US
Practice Address - Phone:505-750-1069
Practice Address - Fax:844-714-2499
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0162171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional