Provider Demographics
NPI:1013495480
Name:GARRETT, KHALILAH (LCSW)
Entity type:Individual
Prefix:MS
First Name:KHALILAH
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KHALILAH
Other - Middle Name:
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4541 BRECCIA LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3118
Mailing Address - Country:US
Mailing Address - Phone:804-564-1308
Mailing Address - Fax:
Practice Address - Street 1:4541 BRECCIA LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-3118
Practice Address - Country:US
Practice Address - Phone:804-564-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4754C1041C0700X
NCC0131691041C0700X
GACSW0066021041C0700X
FLSW179151041C0700X
WVDP009456851041C0700X
VA09040093001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty