Provider Demographics
NPI:1891033726
Name:GREENE, LINDA G (CACII, NCAC II)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:GREENE
Suffix:
Gender:F
Credentials:CACII, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 BIG DAM SWAMP DR
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-6127
Mailing Address - Country:US
Mailing Address - Phone:843-221-4154
Mailing Address - Fax:
Practice Address - Street 1:1423 WINYAH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-4730
Practice Address - Country:US
Practice Address - Phone:843-546-6081
Practice Address - Fax:843-527-1697
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11022411101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11022411OtherSCAADAC CERTIFICATION