Healthcare Provider Details

I. General information

NPI: 1639090244
Provider Name (Legal Business Name): BRANDON JAMES GARRICK DSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 1ST ST NE UNIT 2
WASHINGTON DC
20002-2162
US

IV. Provider business mailing address

4609 JERSEY PINE DR
ROLESVILLE NC
27571-8746
US

V. Phone/Fax

Practice location:
  • Phone: 919-999-7254
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number225692
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: