Provider Demographics
NPI:1700064177
Name:GREEN, SANDRA ADAMS (MSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ADAMS
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:H
Other - Last Name:ADAMS, MSW PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:68 PARKWAY COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5213
Mailing Address - Country:US
Mailing Address - Phone:864-322-7177
Mailing Address - Fax:864-249-1409
Practice Address - Street 1:68 PARKWAY COMMONS WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5213
Practice Address - Country:US
Practice Address - Phone:864-322-7177
Practice Address - Fax:864-249-1409
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ270130281OtherMEDICARE PROVIDER NUMBER
SCR28971Medicare UPIN