Provider Demographics
NPI:1598265662
Name:GARCIA, DARLENE ERICA
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:ERICA
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 1:4930 DAYBREAK CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-2657
Mailing Address - Country:US
Mailing Address - Phone:719-388-1911
Mailing Address - Fax:719-218-9054
Practice Address - Street 1:5540 N ACADEMY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3696
Practice Address - Country:US
Practice Address - Phone:719-388-1911
Practice Address - Fax:719-218-9054
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty