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NPI Code Detail

MEDICARE: KIANGA GREEN MSW

MEDICARE: KIANGA GREEN MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2104100000XSocial Worker

General Provider Information

NPI Number : 1306253471
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIANGA GREEN MSW
Provider Business Mailing Address
First Line : 96 WISTERIA RD
Second Line :
City : GOOSE CREEK
State : SC
Zip : 29445-3495
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 96 WISTERIA RD
Second Line :
City : GOOSE CREEK
State : SC
Zip : 29445-3495
Country : US
Telephone Number : 843-797-7871
Fax Number : 843-797-8638
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2014
Last Update Date : 07/21/2014

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Directions to “ KIANGA GREEN MSW” Practice Location

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