Provider Demographics
NPI:1013341346
Name:RICKARD, GARRICK KEILAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARRICK
Middle Name:KEILAN
Last Name:RICKARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 NORTHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1219
Mailing Address - Country:US
Mailing Address - Phone:425-442-7735
Mailing Address - Fax:
Practice Address - Street 1:1407 NORTHFIELD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1219
Practice Address - Country:US
Practice Address - Phone:425-442-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical