Provider Demographics
NPI:1639468390
Name:GARCIA, KIMBERLY JOYCE (CI)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOYCE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N CARVER ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3634
Mailing Address - Country:US
Mailing Address - Phone:432-570-3390
Mailing Address - Fax:432-570-3375
Practice Address - Street 1:502 N CARVER ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3634
Practice Address - Country:US
Practice Address - Phone:432-570-3390
Practice Address - Fax:432-570-3375
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)