Provider Demographics
NPI:1659797363
Name:GARRISON, CAMERON (LCSW)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61191
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27715-1191
Mailing Address - Country:US
Mailing Address - Phone:704-860-7909
Mailing Address - Fax:
Practice Address - Street 1:2614 KIRK RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2765
Practice Address - Country:US
Practice Address - Phone:704-860-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0100661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1659797363Medicaid
NC1659797363Medicaid