Provider Demographics
NPI:1548372915
Name:GARRISON, CECIL LYNN JR (LCSW, LSATP)
Entity type:Individual
Prefix:MR
First Name:CECIL
Middle Name:LYNN
Last Name:GARRISON
Suffix:JR
Gender:M
Credentials:LCSW, LSATP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14818 WOOD HOME RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1546
Mailing Address - Country:US
Mailing Address - Phone:703-266-7097
Mailing Address - Fax:703-502-7055
Practice Address - Street 1:4213 WALNEY RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2923
Practice Address - Country:US
Practice Address - Phone:703-502-7017
Practice Address - Fax:703-502-7055
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040049191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical