Provider Demographics
NPI:1053325084
Name:GARRETT, WILEY HARD JR (LCSW)
Entity Type:Individual
Prefix:
First Name:WILEY
Middle Name:HARD
Last Name:GARRETT
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 PLOTT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-7148
Mailing Address - Country:US
Mailing Address - Phone:828-230-9591
Mailing Address - Fax:888-227-1739
Practice Address - Street 1:2009 PLOTT CREEK RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-7148
Practice Address - Country:US
Practice Address - Phone:828-230-9591
Practice Address - Fax:888-227-1739
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0031121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003045Medicaid
NC2870193Medicare UPIN