Provider Demographics
NPI:1952189706
Name:GARCIA, KENIA E (LC14104)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:E
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LC14104
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-2324
Mailing Address - Country:US
Mailing Address - Phone:240-426-3696
Mailing Address - Fax:
Practice Address - Street 1:1204 BROOKE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-2324
Practice Address - Country:US
Practice Address - Phone:240-426-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional