Individual
JESSICA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1268 S 4TH ST, HARTSVILLE, SC 29550-0703
(843) 332-3422
(843) 332-3985
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 857-0111
(843) 857-0206
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6910
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC1862
—
SC
01
—
SCS668
MEDICARE
SC
Enumeration date
10/24/2014
Last updated
05/09/2024
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