Provider Demographics
NPI:1568636199
Name:GARVIN, TEAL VENICE (LCSW, LCAS, CCS)
Entity Type:Individual
Prefix:MISS
First Name:TEAL
Middle Name:VENICE
Last Name:GARVIN
Suffix:
Gender:F
Credentials:LCSW, LCAS, CCS
Other - Prefix:MRS
Other - First Name:TEAL
Other - Middle Name:VENICE
Other - Last Name:PEOPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAS, LCSW
Mailing Address - Street 1:5400 DOLPHIN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-2208
Mailing Address - Country:US
Mailing Address - Phone:704-806-5013
Mailing Address - Fax:
Practice Address - Street 1:3126 MILTON RD STE 233
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3782
Practice Address - Country:US
Practice Address - Phone:704-806-5013
Practice Address - Fax:888-502-9591
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9516101YA0400X
NC1429101YA0400X, 251S00000X
SC9764-CP104100000X, 1041C0700X, 251S00000X
NCC0065571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112081Medicaid
SCSW1056Medicaid