Provider Demographics
NPI:1134541295
Name:GARCIA, MEGHAN (LADC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 WOODLAND GRV
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-4512
Mailing Address - Country:US
Mailing Address - Phone:802-473-8421
Mailing Address - Fax:
Practice Address - Street 1:67 EASTERN AVE STE 311
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-5642
Practice Address - Country:US
Practice Address - Phone:802-473-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000589101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1032339Medicaid