Provider Demographics
NPI:1982272175
Name:GARCIA, STACEY MARIE (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 HILL ST
Mailing Address - Street 2:
Mailing Address - City:MATHIS
Mailing Address - State:TX
Mailing Address - Zip Code:78368-3224
Mailing Address - Country:US
Mailing Address - Phone:361-232-3340
Mailing Address - Fax:
Practice Address - Street 1:13330 LEOPARD ST STE 34
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-4481
Practice Address - Country:US
Practice Address - Phone:361-446-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82940101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor