Provider Demographics
NPI:1417784521
Name:GWIN, GARRETT DWAYNE
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:DWAYNE
Last Name:GWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 RISING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2923
Mailing Address - Country:US
Mailing Address - Phone:910-922-5667
Mailing Address - Fax:
Practice Address - Street 1:5531 RISING RIDGE DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-2923
Practice Address - Country:US
Practice Address - Phone:910-922-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist