Provider Demographics
NPI:1790811354
Name:GARCIA, TERRI L (CADC II-CA, CSC)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:F
Credentials:CADC II-CA, CSC
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:L
Other - Last Name:HAGMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC II - CA, CSC
Mailing Address - Street 1:1620 ALPINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1102
Mailing Address - Country:US
Mailing Address - Phone:619-213-0778
Mailing Address - Fax:619-213-0778
Practice Address - Street 1:1620 ALPINE BLVD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1102
Practice Address - Country:US
Practice Address - Phone:619-213-0778
Practice Address - Fax:619-213-0778
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACSC - B1303111533101YP2500X
CABII00460221101YA0400X
CAAII054500418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional