Healthcare Provider Details

I. General information

NPI: 1306417696
Provider Name (Legal Business Name): ANNA GARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 GLASSON WAY
GRASS VALLEY CA
95945-5723
US

IV. Provider business mailing address

15557 LAKE VERA RD
NEVADA CITY CA
95959-9430
US

V. Phone/Fax

Practice location:
  • Phone: 530-470-2425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW99659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: