Provider Demographics
NPI:1376392100
Name:GARRISON, JAMIE (LLMSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S DENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1377
Mailing Address - Country:US
Mailing Address - Phone:313-520-3377
Mailing Address - Fax:
Practice Address - Street 1:41740 6 MILE RD STE 103
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4383
Practice Address - Country:US
Practice Address - Phone:734-542-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511183851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical