Provider Demographics
NPI:1265583678
Name:GARRETT, MIKE (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:GARRETT
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 HARPS MILL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3242
Mailing Address - Country:US
Mailing Address - Phone:919-961-0741
Mailing Address - Fax:
Practice Address - Street 1:7008 HARPS MILL RD STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3242
Practice Address - Country:US
Practice Address - Phone:919-961-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC204879994OtherEIN