Provider Demographics
NPI:1295401990
Name:GARRISON, EMMA LOUISE (LLMSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LOUISE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13726 WARNER RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MI
Mailing Address - Zip Code:49237-9704
Mailing Address - Country:US
Mailing Address - Phone:517-745-2287
Mailing Address - Fax:
Practice Address - Street 1:131 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MI
Practice Address - Zip Code:49241-9702
Practice Address - Country:US
Practice Address - Phone:517-745-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511047041041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool