Provider Demographics
NPI:1033469119
Name:GARNER, ERIN LOLA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LOLA
Last Name:GARNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 W FAIRVIEW AVE
Mailing Address - Street 2:#100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1677
Mailing Address - Country:US
Mailing Address - Phone:208-376-0191
Mailing Address - Fax:
Practice Address - Street 1:10740 W FAIRVIEW AVE
Practice Address - Street 2:#100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-8021
Practice Address - Country:US
Practice Address - Phone:208-376-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID34127104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker