Individual
MS. MARY LOU GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW MSW
Contact information
Practice address
1919 GADSDEN ST, COLUMBIA, SC 29202-8462
(803) 779-5356
(803) 779-2135
Mailing address
PO BOX 8462, 1919 GADSDEN STREET, COLUMBIA, SC 29202-8462
(803) 779-5356
(803) 779-2135
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
3045
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
QM0420
—
SC
Enumeration date
01/22/2007
Last updated
07/08/2007
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