Provider Demographics
NPI:1275541948
Name:DECKER, GEORGENNA R (LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:GEORGENNA
Middle Name:R
Last Name:DECKER
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:R
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LISW-CP
Mailing Address - Street 1:104 CHAMPIONS PT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-2219
Mailing Address - Country:US
Mailing Address - Phone:864-965-8337
Mailing Address - Fax:
Practice Address - Street 1:104 CHAMPIONS PT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-2219
Practice Address - Country:US
Practice Address - Phone:864-965-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical