Healthcare Provider Details

I. General information

NPI: 1235719899
Provider Name (Legal Business Name): LETICIA GARCIA SUD COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10603 DOWNEY AVE
DOWNEY CA
90241-3426
US

IV. Provider business mailing address

2330 BEVERLY BLVD
LOS ANGELES CA
90057-2220
US

V. Phone/Fax

Practice location:
  • Phone: 562-622-2268
  • Fax:
Mailing address:
  • Phone: 213-744-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10442-RAC
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI40040823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: