Basic Information
| Provider Information | |||||||||
| NPI: | 1902813421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARROT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | LCSW, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 PEE DEE AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280014932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042307525 | ||||||||
| FaxNumber: | 7049861505 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 N EUGENE ST | ||||||||
| Address2: | MONARCH | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274012221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366766894 | ||||||||
| FaxNumber: | 3366766490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 06/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3535 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | C001138 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6003575 | 05 | NC | MEDICAID |