Healthcare Provider Details

I. General information

NPI: 1982198149
Provider Name (Legal Business Name): ANDREA RUTH GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 WILLOW PASS RD STE 100
CONCORD CA
94520-7946
US

IV. Provider business mailing address

5599 GONZALEZ CT
CONCORD CA
94521-2435
US

V. Phone/Fax

Practice location:
  • Phone: 925-288-3900
  • Fax:
Mailing address:
  • Phone: 925-238-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1528510923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: