Provider Demographics
NPI:1013670900
Name:GARRETT, JUSTIEN JAMES
Entity Type:Individual
Prefix:
First Name:JUSTIEN
Middle Name:JAMES
Last Name:GARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 PONY RIDGE TURN
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2764
Mailing Address - Country:US
Mailing Address - Phone:804-704-9266
Mailing Address - Fax:
Practice Address - Street 1:3076 PONY RIDGE TURN
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2764
Practice Address - Country:US
Practice Address - Phone:804-704-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst