Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003219684 |
---|---|
Provider Name | Charles Garcia |
First Address | Honolulu, HI 96813-5265 |
Second Address | Honolulu, HI 96813-5265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2014 |
Last Update Date | 26/09/2014 |