Individual
WANIELLE GREENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1270 POLO RD, APT 416, COLUMBIA, SC 29223-8155
(803) 445-8360
Mailing address
1270 POLO RD, APT 416, COLUMBIA, SC 29223-8155
(803) 445-8360
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10711
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123456789
—
SC
Enumeration date
12/23/2015
Last updated
12/23/2015
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