Provider Demographics
NPI:1598239147
Name:GARCIA, VIANCA VANESSA
Entity Type:Individual
Prefix:
First Name:VIANCA
Middle Name:VANESSA
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 1:18837 BROOKHURST ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7301
Mailing Address - Country:US
Mailing Address - Phone:714-536-0077
Mailing Address - Fax:
Practice Address - Street 1:2124 MAIN ST STE 165
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6429
Practice Address - Country:US
Practice Address - Phone:714-536-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician