Provider Demographics
NPI:1760799670
Name:GARCIA, JORGE JOSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:JOSE
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:JOE
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:110 HEIGHTS DR
Mailing Address - Street 2:U3
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2046
Mailing Address - Country:US
Mailing Address - Phone:334-435-8865
Mailing Address - Fax:
Practice Address - Street 1:1500 NE IRVING ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2243
Practice Address - Country:US
Practice Address - Phone:503-233-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor