MEDICARE: MISS TEAL VENICE GARVIN LCSW, LCAS, CCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	9516	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1429	NC
3	104100000X	Social Worker	9764-CP	SC
4	1041C0700X	Clinical Social Worker	9764-CP	SC
5	251S00000X	Community/Behavioral Health Agency	1429	NC
6	251S00000X	Community/Behavioral Health Agency	9764-CP	SC
7	1041C0700X	Clinical Social Worker	C006557	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568636199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TEAL VENICE GARVIN LCSW, LCAS, CCS

Provider Business Mailing Address
First Line	:	5400 DOLPHIN LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-2208
Country	:	US
Telephone Number	:	704-806-5013
Fax Number	:

Provider Business Practice Location Address
First Line	:	3126 MILTON RD STE 233
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3782
Country	:	US
Telephone Number	:	704-806-5013
Fax Number	:	888-502-9591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	03/17/2024

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Directions to “ MISS TEAL VENICE GARVIN LCSW, LCAS, CCS” Practice Location

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