Provider Demographics
NPI:1043219504
Name:GARCIA-O'MALLEY, ADRIENNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:GARCIA-O'MALLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:GARCIA-O'MALLEY, LCSW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, MHR
Mailing Address - Street 1:PO BOX 165941
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-5941
Mailing Address - Country:US
Mailing Address - Phone:214-260-2888
Mailing Address - Fax:
Practice Address - Street 1:2912 N MACARTHUR BLVD
Practice Address - Street 2:STE. 107
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4447
Practice Address - Country:US
Practice Address - Phone:214-260-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7561629699101YA0400X
TXS378421041C0700X
OK24541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)