Provider Demographics
NPI:1376862748
Name:GARCIA, FRED W (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:W
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 WOODLAND DR SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7830
Mailing Address - Country:US
Mailing Address - Phone:360-888-0685
Mailing Address - Fax:
Practice Address - Street 1:3203 WOODLAND DR SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7830
Practice Address - Country:US
Practice Address - Phone:360-888-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600833531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical