Healthcare Provider Details

I. General information

NPI: 1982253399
Provider Name (Legal Business Name): BLANCA ALICIA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 249
LAS CRUCES NM
88001-1243
US

IV. Provider business mailing address

505 S MAIN ST STE 249
LAS CRUCES NM
88001-1243
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-5823
  • Fax:
Mailing address:
  • Phone: 575-527-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB20230434
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: