Provider Demographics
NPI:1083382964
Name:GARCIA, CRYSTAL ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ELIZABETH
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8713
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-8713
Mailing Address - Country:US
Mailing Address - Phone:360-790-8602
Mailing Address - Fax:360-925-3037
Practice Address - Street 1:4932 SISKIYOU LOOP SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-7910
Practice Address - Country:US
Practice Address - Phone:360-790-8602
Practice Address - Fax:360-925-3037
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609279251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical