Provider Demographics
NPI:1639442320
Name:GARNER, JACKIE (ASW)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23201 MILL CREEK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7906
Mailing Address - Country:US
Mailing Address - Phone:949-463-5323
Mailing Address - Fax:949-460-5322
Practice Address - Street 1:23201 MILL CREEK DR STE 220
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7906
Practice Address - Country:US
Practice Address - Phone:949-463-5323
Practice Address - Fax:949-460-5322
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW27353104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker