Healthcare Provider Details

I. General information

NPI: 1023705688
Provider Name (Legal Business Name): RAVENODELL WILLIAM GARRITY PMHNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILLIAM GARRITY PMHNP-C

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date: 09/29/2025
Reactivation Date: 10/17/2025

III. Provider practice location address

2525 COURT DR
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

2525 COURT DR
GASTONIA NC
28054-2140
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2000
  • Fax:
Mailing address:
  • Phone: 704-834-2000
  • Fax: 704-671-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5023238
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: