Provider Demographics
NPI:1083919260
Name:GARCIA, ELICIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELICIA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CLINGING VINE PL
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5066
Mailing Address - Country:US
Mailing Address - Phone:407-310-2773
Mailing Address - Fax:
Practice Address - Street 1:1035 S STATE ROAD 7 STE 209
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6136
Practice Address - Country:US
Practice Address - Phone:561-448-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH12029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor