Provider Demographics
NPI:1891910113
Name:GARRICK, MADRIAN GLOVER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MADRIAN
Middle Name:GLOVER
Last Name:GARRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 FAIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6607
Mailing Address - Country:US
Mailing Address - Phone:910-550-3803
Mailing Address - Fax:910-550-3803
Practice Address - Street 1:803 STAMPER RD STE G
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4193
Practice Address - Country:US
Practice Address - Phone:910-223-7114
Practice Address - Fax:910-223-0098
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106227Medicaid