Basic Information
| Provider Information | |||||||||
| NPI: | 1194795260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARNER | ||||||||
| FirstName: | DARRELL | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1025 CANTERBERRY FARM RD | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270537543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363513937 | ||||||||
| FaxNumber: | 3363516331 | ||||||||
| Practice Location | |||||||||
| Address1: | 865 W LAKE DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT AIRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270302157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367867199 | ||||||||
| FaxNumber: | 3363516331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C001190 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 10097525 | 05 | VA | MEDICAID | 2031578 | 01 | NC | CIGNA | OTHER | 6002453 | 05 | NC | MEDICAID | B5140 | 01 | NC | MEDCOST | OTHER | 12840 | 01 | NC | PARTNERS | OTHER | 6223730 | 01 | NC | UNITED HEALTH CARE | OTHER | 1174Y | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 460508 | 01 | NC | VALUE OPTIONS | OTHER | 308914 | 01 | NC | MAGELLAN | OTHER |