Provider Demographics
NPI:1720649890
Name:GARCIA, MARYANN KATHRYN (LPCA)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:KATHRYN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 HAMPTON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-9259
Mailing Address - Country:US
Mailing Address - Phone:919-717-0574
Mailing Address - Fax:
Practice Address - Street 1:5805 HAMPTON RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-9259
Practice Address - Country:US
Practice Address - Phone:919-717-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional