Healthcare Provider Details

I. General information

NPI: 1235379728
Provider Name (Legal Business Name): COURTNEY C GREEN MSP, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY MACKEY MSP, CCC-SLP

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 09/16/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 PLEASANT ROAD SUITE 101
FORT MILL SC
29708-9494
US

IV. Provider business mailing address

1678 DURANT DRIVE
ROCK HILL SC
29732
US

V. Phone/Fax

Practice location:
  • Phone: 800-779-4089
  • Fax: 803-547-9706
Mailing address:
  • Phone: 803-415-0425
  • Fax: 803-366-5027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4319
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: