Provider Demographics
NPI:1689721748
Name:GARCIA, SUSAN LORRAINE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LORRAINE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 E COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3776
Mailing Address - Country:US
Mailing Address - Phone:719-634-1825
Mailing Address - Fax:719-634-1874
Practice Address - Street 1:961 E COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3776
Practice Address - Country:US
Practice Address - Phone:719-634-1825
Practice Address - Fax:719-634-1874
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health