Provider Demographics
NPI:1023705688
Name:GARRITY, RAVENODELL (PMHNP-C)
Entity type:Individual
Prefix:MR
First Name:RAVENODELL
Middle Name:
Last Name:GARRITY
Suffix:
Gender:M
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:GARRITY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-C
Mailing Address - Street 1:23 UNION ST N STE B
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-2947
Practice Address - Country:US
Practice Address - Phone:980-925-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2025-10-17
Deactivation Date:2025-09-29
Deactivation Code:
Reactivation Date:2025-10-17
Provider Licenses
StateLicense IDTaxonomies
NC5023238363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health