Teal Venice Garvin, LCSW, LCAS, CCS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C006557 Issued in NC

Practice address

3126 Milton Rd Ste 233
Charlotte, NC 28215-3782

Phone

(704) 806-5013

Fax

(888) 502-9591

NPI assigned

Apr 15, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 7

Addresses

Other identifiers 2

Other names 1

• Mrs. Teal Venice Peoples Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710633600000",
    "number": "1568636199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 DOLPHIN LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282152208",
            "telephone_number": "704-806-5013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3126 MILTON RD STE 233",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282153782",
            "telephone_number": "704-806-5013",
            "fax_number": "888-502-9591"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5400 Dolphin Ln",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282152208",
            "country_code": "US",
            "telephone_number": "704-806-5013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARVIN",
        "first_name": "TEAL",
        "middle_name": "VENICE",
        "name_prefix": "Miss",
        "credential": "LCSW, LCAS, CCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-15",
        "last_updated": "2024-03-17",
        "certification_date": "2024-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "9516",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1429",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "SC",
            "license": "9764-CP",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "9764-CP",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "1429",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "SC",
            "license": "9764-CP",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C006557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6112081",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SW1056",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TEAL",
            "last_name": "PEOPLES",
            "middle_name": "VENICE",
            "prefix": "MRS.",
            "credential": "LCAS, LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael Steven Gart, MD
• Kenyetta Garth, MA, CLD
• Jennifer Anne Gartland, RD
• Seth Gartner, MD
• Destiny Garvin
• Christopher Paul Garwacki, MD
• Gary D Waldman MD PA
• Joy Elaine Gary, M.D.
• Kishawna Denae Gary, MSW, LCSW-A
• Latasha G. Gary, LCMHC

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2024; 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.