Provider Demographics
NPI:1558652545
Name:GARRATY, MARY ALLENE (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ALLENE
Last Name:GARRATY
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WOOD DUCK DR
Mailing Address - Street 2:
Mailing Address - City:CURRITUCK
Mailing Address - State:NC
Mailing Address - Zip Code:27929-9632
Mailing Address - Country:US
Mailing Address - Phone:757-286-5239
Mailing Address - Fax:
Practice Address - Street 1:860 GREENBRIER CIR STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2640
Practice Address - Country:US
Practice Address - Phone:757-548-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001922101YP2500X
NC3063101YP2500X
VA753149110101YP2500X, 106H00000X
VA0717000471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional