Provider Demographics
NPI:1528573730
Name:GARCIA, EZEQUIEL G (LLMSW)
Entity Type:Individual
Prefix:
First Name:EZEQUIEL
Middle Name:G
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3780
Mailing Address - Country:US
Mailing Address - Phone:616-965-8390
Mailing Address - Fax:616-254-8196
Practice Address - Street 1:2303 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507
Practice Address - Country:US
Practice Address - Phone:616-965-8390
Practice Address - Fax:616-254-8196
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI6801102647104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker