Provider Demographics
NPI:1841506193
Name:GARRISON, DESIREE MICHELLE (LCDC-2, SWA)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:MICHELLE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LCDC-2, SWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 KINGSVIEW DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9562
Mailing Address - Country:US
Mailing Address - Phone:513-228-7854
Mailing Address - Fax:513-228-7848
Practice Address - Street 1:953 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2921
Practice Address - Country:US
Practice Address - Phone:937-383-4441
Practice Address - Fax:937-383-2348
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHW-0900049104100000X
OHLCDC.131024-2101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker