Provider Demographics
NPI:1184472854
Name:GARCIA, MIA (MA, LMHCA, NCC, PSC)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA, LMHCA, NCC, PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 HOLLYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1318
Mailing Address - Country:US
Mailing Address - Phone:704-419-9128
Mailing Address - Fax:
Practice Address - Street 1:7215 LEBANON RD STE C
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9027
Practice Address - Country:US
Practice Address - Phone:980-403-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health