Healthcare Provider Details

I. General information

NPI: 1508217860
Provider Name (Legal Business Name): NICKOLE GARCIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 JOHN ST SE
ALBUQUERQUE NM
87102-4235
US

IV. Provider business mailing address

912 1ST ST NW
ALBUQUERQUE NM
87102-2355
US

V. Phone/Fax

Practice location:
  • Phone: 505-307-5032
  • Fax:
Mailing address:
  • Phone: 505-224-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11470
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: