=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710839451
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BREYAUNA JAY-CHELLE GREEN LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2026
-----------------------------------------------------
Last Update Date | 02/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 403 STONY LANDING RD
-----------------------------------------------------
City | MONCKS CORNER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29461-3967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-761-8282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 VIRGINIA DR
-----------------------------------------------------
City | WOODRUFF
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29388-8919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-761-8282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 17937
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------