Provider Demographics
NPI:1255020111
Name:SETNESS, GARRISON KENNETH
Entity type:Individual
Prefix:
First Name:GARRISON
Middle Name:KENNETH
Last Name:SETNESS
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 1:24560 SOUTHPOINT DR STE 260
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3505
Mailing Address - Country:US
Mailing Address - Phone:703-841-1290
Mailing Address - Fax:
Practice Address - Street 1:24560 SOUTHPOINT DR
Practice Address - Street 2:SUITE 260
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3505
Practice Address - Country:US
Practice Address - Phone:703-841-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health