Provider Demographics
NPI:1033143896
Name:LEGREE, ADA M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ADA
Middle Name:M
Last Name:LEGREE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ADA
Other - Middle Name:BANKS
Other - Last Name:LEGREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2319 ST MATTHEWS ROAD
Mailing Address - Street 2:ORANGEBURG AREA MENTAL HEALTH CTR
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118
Mailing Address - Country:US
Mailing Address - Phone:803-536-1571
Mailing Address - Fax:803-534-1693
Practice Address - Street 1:2319 ST MATTHEWS ROAD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118
Practice Address - Country:US
Practice Address - Phone:803-536-1571
Practice Address - Fax:803-534-1693
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3373104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3373OtherDEPT OF LABOR
SC413093Medicaid
3345Medicare ID - Type Unspecified