Provider Demographics
NPI:1629009824
Name:GARRISON, DONNA ADAIR (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:ADAIR
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 J N PEASE PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4505
Mailing Address - Country:US
Mailing Address - Phone:704-591-2466
Mailing Address - Fax:704-548-9855
Practice Address - Street 1:1945 J N PEASE PL
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4505
Practice Address - Country:US
Practice Address - Phone:704-591-2466
Practice Address - Fax:704-548-9855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0022091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1234XOtherBLUE CROSS BLUE SHIELD
NC6002637Medicaid