Provider Demographics
NPI:1861730095
Name:GARRISON, EDWARD (LCAS-A)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GARRISON
Suffix:
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 GRESHAM GROVE LN APT 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-8065
Mailing Address - Country:US
Mailing Address - Phone:704-400-2010
Mailing Address - Fax:
Practice Address - Street 1:2840 GRESHAM GROVE LN APT 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-8065
Practice Address - Country:US
Practice Address - Phone:704-400-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2769-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)