Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YM0800X | Mental Health Counselor | 6301010789 | MI |
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist |
NPI | 1003061698 |
---|---|
Provider Name | Mr. George Garcia |
First Address | Millington, MI 48746-9608 |
Second Address | Millington, MI 48746-9608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2008 |
Last Update Date | 24/11/2008 |