MEDICARE: DALLAS GREENE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-84738	NC

General Provider Information

NPI Number	:	1821679325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLAS GREENE

Provider Business Mailing Address
First Line	:	1899 TATE BLVD SE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-4200
Country	:	US
Telephone Number	:	828-358-0976
Fax Number	:

Provider Business Practice Location Address
First Line	:	1899 TATE BLVD SE STE 2106
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-4200
Country	:	US
Telephone Number	:	828-358-0976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	03/10/2026

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Directions to “ DALLAS GREENE ” Practice Location

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