Individual
FERTASIA ME'SHAUN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
301 PALMETTO PARK BLVD, LEXINGTON, SC 29072-7872
(803) 996-1500
Mailing address
928 SHORT ST, COLUMBIA, SC 29205-1141
(803) 873-6417
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
13382
SC
Other
Enumeration date
06/14/2023
Last updated
06/14/2023
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