Provider Demographics
NPI:1245031590
Name:GARCIA, CORALANN MARIE (MC, LAC)
Entity type:Individual
Prefix:
First Name:CORALANN
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-218 MAKAIKE PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5129
Mailing Address - Country:US
Mailing Address - Phone:808-258-0008
Mailing Address - Fax:
Practice Address - Street 1:91-218 MAKAIKE PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5129
Practice Address - Country:US
Practice Address - Phone:808-258-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23397101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor