Provider Demographics
NPI:1871858928
Name:GARCES, LINA MARIA
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:MARIA
Last Name:GARCES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 LIBERTY BANK LN STE 230
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5756
Mailing Address - Country:US
Mailing Address - Phone:954-661-3222
Mailing Address - Fax:
Practice Address - Street 1:1230 LIBERTY BANK LN STE 230
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5756
Practice Address - Country:US
Practice Address - Phone:954-661-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275086103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst