Provider Demographics
NPI:1427177799
Name:GETMAN, MIRANDA BROOKE (MS)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:BROOKE
Last Name:GETMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 PARK PLACE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4261
Mailing Address - Country:US
Mailing Address - Phone:704-778-3828
Mailing Address - Fax:
Practice Address - Street 1:845 CHURCH STREET NORTH
Practice Address - Street 2:YOUTH VILLAGES SUITE 305
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-262-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health