Healthcare Provider Details

I. General information

NPI: 1417784521
Provider Name (Legal Business Name): GARRETT DWAYNE GWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5531 RISING RIDGE DR
HOPE MILLS NC
28348-2923
US

IV. Provider business mailing address

5531 RISING RIDGE DR
HOPE MILLS NC
28348-2923
US

V. Phone/Fax

Practice location:
  • Phone: 910-922-5667
  • Fax:
Mailing address:
  • Phone: 910-922-5667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: