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General NPI Number Information
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NPI Number | 1487053153
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Entity Type | Individual
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Provider Name | MONIQUE GREEN
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Gender | Female
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 4762 RIVERS AVE STE A
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-6691
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Country | US
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Telephone | 843-321-5882
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Fax | 888-656-6393
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Provider Business Mailing Address
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Address Line | 8420 CAROLINA LILY LN
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City | CHARLOTTE
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State | NC
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Zip | 28262-6470
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Country | US
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Telephone | 704-953-7541
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Fax | 888-656-6393
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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