JESSICA GREEN LPC
NPI 1104221811
Counselor - Mental Health in Hartsville, SC

Q: What is Jessica Green's NPI number?

The NPI number for Jessica Green is 1104221811. It was assigned to this individual provider in the NPPES registry on October 24, 2014.

Q: What is Jessica Green's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Jessica Green was last updated on May 9, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since October 24, 2014PECOS EnrolledAccepts Medicare Assignment

1268 S 4TH ST, HARTSVILLE, SC 29550(843) 332-3422(843) 332-3985 Get Directions Write a Review

NPPES record last updated: May 9, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 9, 2024, Jun 25, 2020, Jan 22, 2016 (3 updates tracked since 2016).

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About Jessica Green Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA GREEN LPC (NPI 1104221811) is an individual mental health provider in Hartsville, South Carolina, licensed in South Carolina (6910) and active in the NPI registry since October 2014. She is enrolled in Medicare PECOS and is a graduate of Other (2010).

NPPES Registry Identity

NPI1104221811

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameJESSICA GREENCredential: LPC

Location Address1268 S 4TH STHartsville, SC 29550-0703

Mailing AddressPo Box 1090Hartsville, SC 29551-1090 · (843) 857-0111 · Fax (843) 857-0206

Phone(843) 332-3422

Fax(843) 332-3985

Sole ProprietorNo

Medical School CMSOtherGraduated 2010

Enumeration DateOctober 24, 2014

Last NPPES UpdateMay 9, 20243 updates tracked since enumeration

NPPES CertifiedMay 9, 2024

✔ NPI 1104221811 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in SC · 6910

1268 S 4TH ST, Hartsville, SC 29550

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Other Identifiers 2

MedicaidPC1862SC

OtherSCS668SC · Medicare

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, BlueCross BlueShield of South Carolina and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jessica Green Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8325488968

PECOS Enrollment IDI20240430003515

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. ZITA ACUNA ANDRESKI APRN FNP-C

Nurse Practitioner (Family)