Provider Demographics
NPI:1316593064
Name:GARCIA, CAROLE A (MFT)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 SHOREHEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5647
Mailing Address - Country:US
Mailing Address - Phone:310-508-7010
Mailing Address - Fax:
Practice Address - Street 1:3534 SHOREHEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5647
Practice Address - Country:US
Practice Address - Phone:310-508-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC79285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist