Provider Demographics
NPI:1881655595
Name:GARRETT, VIRGINIA DIANE (PHD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DIANE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7916 WRENWOOD BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1782
Mailing Address - Country:US
Mailing Address - Phone:225-302-5092
Mailing Address - Fax:225-615-7329
Practice Address - Street 1:7916 WRENWOOD BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1782
Practice Address - Country:US
Practice Address - Phone:225-302-5092
Practice Address - Fax:225-615-7329
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH5829OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
LAH5829OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
LA1881655595OtherNATIONAL PROVIDER IDENTIFIER