Provider Demographics
NPI:1194036657
Name:GARCIA, LILLIANA (MA)
Entity Type:Individual
Prefix:
First Name:LILLIANA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 MARINER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4090
Mailing Address - Country:US
Mailing Address - Phone:262-886-8702
Mailing Address - Fax:
Practice Address - Street 1:6939 MARINER DR
Practice Address - Street 2:SUITE C
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4090
Practice Address - Country:US
Practice Address - Phone:262-886-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI465226101YP2500X
WI465-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional