Provider Demographics
NPI:1477431989
Name:GARRETT, CHARLENE FAYE
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:FAYE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2178
Mailing Address - Country:US
Mailing Address - Phone:601-447-4658
Mailing Address - Fax:
Practice Address - Street 1:2007 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2178
Practice Address - Country:US
Practice Address - Phone:228-369-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24-369625106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician