Provider Demographics
NPI:1821682782
Name:GARCIA, ADAN A (CO61119746)
Entity Type:Individual
Prefix:
First Name:ADAN
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:M
Credentials:CO61119746
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-1207
Mailing Address - Country:US
Mailing Address - Phone:509-457-5653
Mailing Address - Fax:
Practice Address - Street 1:201 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2348
Practice Address - Country:US
Practice Address - Phone:509-457-5653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61119746101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)