Provider Demographics
NPI:1225547961
Name:GARCIA, ABRAHAM V JR (CAADE)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:V
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:CAADE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4607
Mailing Address - Country:US
Mailing Address - Phone:805-332-4568
Mailing Address - Fax:805-332-3487
Practice Address - Street 1:801 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4607
Practice Address - Country:US
Practice Address - Phone:805-332-4568
Practice Address - Fax:805-332-3487
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12265-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033665526Medicaid
CA1447244256Medicaid