Provider Demographics
NPI:1568075612
Name:SERRELS, GARRETT (MA)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:SERRELS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 RESERVOIR ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8722
Mailing Address - Country:US
Mailing Address - Phone:540-236-8219
Mailing Address - Fax:
Practice Address - Street 1:20 W WOLFE ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-3807
Practice Address - Country:US
Practice Address - Phone:540-405-9579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health