Provider Demographics
NPI:1639596646
Name:GARCIA, DESIREE (MA)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 ATRISCO DR NW STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4902
Mailing Address - Country:US
Mailing Address - Phone:505-932-8979
Mailing Address - Fax:
Practice Address - Street 1:3809 ATRISCO DR NW STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4902
Practice Address - Country:US
Practice Address - Phone:505-932-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84-4728550Medicaid
NM27671283Medicaid