Provider Demographics
NPI:1841587201
Name:GARCIA, DIANA NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:NICOLE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LPC
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 460429
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78246-0429
Mailing Address - Country:US
Mailing Address - Phone:210-446-8255
Mailing Address - Fax:888-823-3497
Practice Address - Street 1:7300 BLANCO RD
Practice Address - Street 2:SUITE 501
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4936
Practice Address - Country:US
Practice Address - Phone:210-446-8255
Practice Address - Fax:888-823-3497
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65945101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2872251-01Medicaid