Provider Demographics
NPI:1962036566
Name:GARCIA, JENNIFER (LPCA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16433 BARCICA LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8723
Mailing Address - Country:US
Mailing Address - Phone:980-494-3205
Mailing Address - Fax:
Practice Address - Street 1:19837 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8830
Practice Address - Country:US
Practice Address - Phone:980-494-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA15428OtherN/A