Healthcare Provider Details

I. General information

NPI: 1245054931
Provider Name (Legal Business Name): NA'THALYN N GREEN MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HAZZARD CREEK VLG
RIDGELAND SC
29936-8266
US

IV. Provider business mailing address

PO BOX 6514
BEAUFORT SC
29903-6514
US

V. Phone/Fax

Practice location:
  • Phone: 843-645-7700
  • Fax: 888-908-7339
Mailing address:
  • Phone: 843-694-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17270
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: