Provider Demographics
NPI:1760692859
Name:GARCIA, MICHELLE R (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E GILBERT ST OFC 195
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0928
Mailing Address - Country:US
Mailing Address - Phone:909-386-8510
Mailing Address - Fax:909-387-7757
Practice Address - Street 1:820 E GILBERT ST OFC 195
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0928
Practice Address - Country:US
Practice Address - Phone:909-387-7101
Practice Address - Fax:909-387-7757
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA5360111101YA0400X
CAASW80609101YM0800X
CA1129371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4983OtherSIMON STAFF NUMBER