=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790418101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELA ESTEFANIA GARRETT MA, LCMHC-A, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2022
-----------------------------------------------------
Last Update Date | 07/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18145 W CATAWBA AVE
-----------------------------------------------------
City | CORNELIUS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28031-5641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-756-1615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8130 KINGS CREEK DR
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28273-5618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-495-4405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | A17630
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------