Provider Demographics
NPI:1639879570
Name:GARCIA, CRYSTAL NICOLE (LMHC, LCACA, NCC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMHC, LCACA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12334 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7229
Mailing Address - Country:US
Mailing Address - Phone:219-775-4161
Mailing Address - Fax:
Practice Address - Street 1:3503 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-1233
Practice Address - Country:US
Practice Address - Phone:219-880-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87900042A101YA0400X
IN39004337A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)