Provider Demographics
NPI:1730229733
Name:GARCIA, CONNIE THERESA
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:THERESA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:THERESA
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6214
Mailing Address - Country:US
Mailing Address - Phone:209-381-6830
Mailing Address - Fax:209-383-9666
Practice Address - Street 1:480 EAST 13TH STREET
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-4600
Practice Address - Country:US
Practice Address - Phone:209-381-6800
Practice Address - Fax:209-725-3883
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW15906101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor