Healthcare Provider Details

I. General information

NPI: 1558839050
Provider Name (Legal Business Name): MARIA DE LOS ANGELES GARCIA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA D GARCIA LMHC

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 01/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 NE 195TH ST APT 121E
MIAMI FL
33179-3309
US

IV. Provider business mailing address

5124 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6518
US

V. Phone/Fax

Practice location:
  • Phone: 786-837-1160
  • Fax:
Mailing address:
  • Phone: 954-894-7411
  • Fax: 954-965-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16071
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: