Provider Demographics
NPI:1851931612
Name:GARCIA, JUAN WILLIAM (S/T, MFT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:WILLIAM
Last Name:GARCIA
Suffix:
Gender:M
Credentials:S/T, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 INGERSOLL ST # 152
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-2600
Mailing Address - Country:US
Mailing Address - Phone:573-842-7374
Mailing Address - Fax:
Practice Address - Street 1:1727 BOXWOOD PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2328
Practice Address - Country:US
Practice Address - Phone:706-569-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist