Provider Demographics
NPI:1336223338
Name:FLEMING, GENEVA (LISW, CSW)
Entity Type:Individual
Prefix:MRS
First Name:GENEVA
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LISW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SANDY DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-4059
Mailing Address - Country:US
Mailing Address - Phone:843-761-0013
Mailing Address - Fax:843-761-0766
Practice Address - Street 1:202 SANDY DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-4059
Practice Address - Country:US
Practice Address - Phone:843-761-0013
Practice Address - Fax:843-761-0766
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0067281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ339300281Medicare UPIN