Individual
SALENA D GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4996 BALLANTINE DR, SUMMERVILLE, SC 29485-9010
(843) 823-4783
Mailing address
4996 BALLANTINE DR, SUMMERVILLE, SC 29485-9010
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
04/13/2022
Last updated
04/13/2022
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