MEDICARE: JOHN JONES MORRIS FAUBERT LMSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1861137978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JONES MORRIS FAUBERT LMSW

Provider Business Mailing Address
First Line	:	2510 WADE HAMPTON BLVD # A
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-1168
Country	:	US
Telephone Number	:	864-509-0774
Fax Number	:	877-629-7598

Provider Business Practice Location Address
First Line	:	2510 WADE HAMPTON BLVD # A
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-1168
Country	:	US
Telephone Number	:	864-509-0774
Fax Number	:	877-629-7598

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

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	05/03/2022

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