Provider Demographics
NPI:1912246554
Name:GREENE, ANGELA W (LMSW, CAC I)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:W
Last Name:GREENE
Suffix:
Gender:F
Credentials:LMSW, CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N HARVIN ST
Mailing Address - Street 2:3RD FL.
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4956
Mailing Address - Country:US
Mailing Address - Phone:803-775-6815
Mailing Address - Fax:803-773-6232
Practice Address - Street 1:9711 DAVID TAYLOR DR APT 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2370
Practice Address - Country:US
Practice Address - Phone:980-949-6846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93801041C0700X
SC1211202101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical