Provider Demographics
NPI:1154477115
Name:GARRISON, RAYMOND EUGENE (LICENSED MARRIAGE AN)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:EUGENE
Last Name:GARRISON
Suffix:
Gender:M
Credentials:LICENSED MARRIAGE AN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 CLEMSON AVE
Mailing Address - Street 2:ST MARTINS IN THE FIELD EPISCOPAL CHURCH
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206
Mailing Address - Country:US
Mailing Address - Phone:803-787-0392
Mailing Address - Fax:803-782-5658
Practice Address - Street 1:5220 CLEMSON AVE
Practice Address - Street 2:ST MARTINS IN THE FIELD EPISCOPAL CHURCH
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206
Practice Address - Country:US
Practice Address - Phone:803-787-0392
Practice Address - Fax:803-782-5658
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1305LMFT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist