Provider Demographics
NPI:1316413248
Name:GARCIA, ANGELA PATRICIA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:PATRICIA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22791 JUNEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-9152
Mailing Address - Country:US
Mailing Address - Phone:574-849-1995
Mailing Address - Fax:
Practice Address - Street 1:22791 JUNEBERRY CT
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-9152
Practice Address - Country:US
Practice Address - Phone:574-849-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000391A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health