Green, Mary Lou

Green, Mary Lou is an individual health care provider with primary practice located at 1919 Gadsden St , Columbia SC 29202-8462. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Green, Mary Lou can be contacted via phone (803) 779-5356.

Contact Information

Primary practice address
1919 Gadsden St Columbia SC 29202-8462
Phone: (803) 779-5356
Fax: (803) 779-2135
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X 3045 South Carolina

Profile Details

NPI number 1629122395
LBN Legal business name Green, Mary Lou
Credentials LMSW MSW
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 22nd, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629122395 NPPES
South Carolina MEDICAID QM0420

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