Provider Demographics
NPI:1245054931
Name:GREEN, NA'THALYN N (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:NA'THALYN
Middle Name:N
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6514
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29903-6514
Mailing Address - Country:US
Mailing Address - Phone:843-694-3707
Mailing Address - Fax:
Practice Address - Street 1:77 HAZZARD CREEK VLG
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8266
Practice Address - Country:US
Practice Address - Phone:843-645-7700
Practice Address - Fax:888-908-7339
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17270104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker