Provider Demographics
NPI:1447302401
Name:V. DIANE GARRETT, PH.D.
Entity type:Organization
Organization Name:V. DIANE GARRETT, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-302-5092
Mailing Address - Street 1:7916 WRENWOOD BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1782
Mailing Address - Country:US
Mailing Address - Phone:225-302-5092
Mailing Address - Fax:225-615-7329
Practice Address - Street 1:7916 WRENWOOD BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1782
Practice Address - Country:US
Practice Address - Phone:225-302-5092
Practice Address - Fax:225-615-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty