Provider Demographics
NPI:1407437015
Name:GARCIA, JACK (MSSW)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3034
Mailing Address - Country:US
Mailing Address - Phone:859-314-2236
Mailing Address - Fax:
Practice Address - Street 1:337 12TH ST
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3034
Practice Address - Country:US
Practice Address - Phone:859-314-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor