Provider Demographics
NPI:1700207438
Name:GARZA, TERESA ANN (CDP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:GARZA
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDP
Mailing Address - Street 1:3773 MARTIN WAY E STE 105
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4400
Mailing Address - Country:US
Mailing Address - Phone:360-688-7312
Mailing Address - Fax:360-688-7318
Practice Address - Street 1:3773 MARTIN WAY E BLDG A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5048
Practice Address - Country:US
Practice Address - Phone:360-688-7312
Practice Address - Fax:360-688-7318
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 000058101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)