Provider Demographics
NPI:1144660176
Name:GARRETT, MARTHA SUE (LPA)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:SUE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 WESTOVER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2959
Mailing Address - Country:US
Mailing Address - Phone:512-695-5456
Mailing Address - Fax:
Practice Address - Street 1:236 WESTOVER HILLS DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2959
Practice Address - Country:US
Practice Address - Phone:512-695-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12653103T00000X
NC3403103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist