NPIMap

Organization Active NPI

Center for Family and Individual Growth, PA

  • Clinical Social Worker
  • Mount Airy, NC
National Provider Identifier
1154637585
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C001190 Issued in NC
Legal business name
CENTER FOR FAMILY AND INDIVIDUAL GROWTH, PA
Practice address
865 W Lake Dr
Mount Airy, NC 27030-2157
Phone
(336) 786-7199
Fax
(336) 719-2313
NPI assigned
Aug 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Darrell Thomas Garner, LCSW
Title
President/Provider
Phone
(336) 786-7199

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X C001190 NC Primary

Addresses

Primary practice location

865 W Lake Dr
Mount Airy, NC 27030-2157

Mailing address

865 W Lake Dr
Mount Airy, NC 27030-2157
Phone (336) 786-7199

Other identifiers 7

IdentifierTypeStateIssuer
1174YOtherNCBLUE CROSS BLUE SHIELD
308914OtherNCMAGELLAN
460508OtherNCVALUE OPTIONS
2031578OtherNCCIGNA
6002453MedicaidNC
6223730OtherNCUNITED HEALTH CARE
B5140OtherNCMEDCOST

National Provider Directory

National Provider Directory

Locations

865 Westlake Dr
Ste 300
Mount Airy, NC 27030
Phone (336) 786-7199

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282521600000",
    "number": "1154637585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 W LAKE DR",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270302157",
            "telephone_number": "336-786-7199",
            "fax_number": "336-719-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 W LAKE DR",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270302157",
            "telephone_number": "336-786-7199",
            "fax_number": "336-719-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR FAMILY AND INDIVIDUAL GROWTH, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-23",
        "last_updated": "2010-08-23",
        "status": "A",
        "authorized_official_last_name": "GARNER",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT/PROVIDER",
        "authorized_official_telephone_number": "336-786-7199",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C001190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1174Y",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "308914",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "460508",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2031578",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002453",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "6223730",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "B5140",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Airy, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.