Healthcare Provider Details

I. General information

NPI: 1649544354
Provider Name (Legal Business Name): HEATHER N. GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CARDENAS DR NE
ALBUQUERQUE NM
87108-1720
US

IV. Provider business mailing address

PO BOX 3382
ALBUQUERQUE NM
87190-3382
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-8168
  • Fax:
Mailing address:
  • Phone: 870-698-6064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0222251
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: