1194795260 NPI number — MR. DARRELL THOMAS GARNER LCSW

Table of content: CAYLA FIGUEROA (NPI 1285467522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194795260 NPI number — MR. DARRELL THOMAS GARNER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARNER
Provider First Name:
DARRELL
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194795260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1025 CANTERBERRY FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27053-7543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-351-3937
Provider Business Mailing Address Fax Number:
336-351-6331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
865 W LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27030-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-786-7199
Provider Business Practice Location Address Fax Number:
336-351-6331
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C001190 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10097525 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2031578 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6002453 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: B5140 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 12840 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6223730 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1174Y . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 460508 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 308914 . This is a "MAGELLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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