Provider Demographics
NPI:1194795260
Name:GARNER, DARRELL THOMAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:THOMAS
Last Name:GARNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1025 CANTERBERRY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27053-7543
Mailing Address - Country:US
Mailing Address - Phone:336-351-3937
Mailing Address - Fax:336-351-6331
Practice Address - Street 1:865 W LAKE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2157
Practice Address - Country:US
Practice Address - Phone:336-786-7199
Practice Address - Fax:336-351-6331
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0011901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10097525Medicaid
NC2031578OtherCIGNA
NC6002453Medicaid
NCB5140OtherMEDCOST
NC12840OtherPARTNERS
NC6223730OtherUNITED HEALTH CARE
NC1174YOtherBLUE CROSS BLUE SHIELD
NC460508OtherVALUE OPTIONS
NC308914OtherMAGELLAN
NC6002453Medicaid