Provider Demographics
NPI:1184320178
Name:GARCIA, TANIA MARIE (LSW)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:MARIE
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25224 W EAMES ST
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5215
Mailing Address - Country:US
Mailing Address - Phone:815-467-8181
Mailing Address - Fax:
Practice Address - Street 1:25224 W EAMES ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5215
Practice Address - Country:US
Practice Address - Phone:815-791-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150110106101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor