Healthcare Provider Details

I. General information

NPI: 1215856794
Provider Name (Legal Business Name): SARA MACKENZIE GRIECO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 SALTERBECK ST STE 206
MOUNT PLEASANT SC
29466-7119
US

IV. Provider business mailing address

2080 TURTLE CREEK WAY
LAWRENCEVILLE GA
30043-6944
US

V. Phone/Fax

Practice location:
  • Phone: 843-732-0187
  • Fax:
Mailing address:
  • Phone: 678-451-5027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11054
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: