Provider Demographics
NPI:1568743508
Name:GARROW, JOANNA VICTORIA (LMSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:VICTORIA
Last Name:GARROW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 W FOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-9519
Mailing Address - Country:US
Mailing Address - Phone:231-233-5663
Mailing Address - Fax:
Practice Address - Street 1:101 S JAMES ST STE 215
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2166
Practice Address - Country:US
Practice Address - Phone:231-845-2900
Practice Address - Fax:231-845-2905
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010919121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801091912OtherSTATE OF MI LICENSE