Healthcare Provider Details

I. General information

NPI: 1952134876
Provider Name (Legal Business Name): KRISTIN M GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 03/08/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CROWSNEST CT
SIMPSONVILLE SC
29680-6660
US

IV. Provider business mailing address

9 CROWSNEST CT
SIMPSONVILLE SC
29680-6660
US

V. Phone/Fax

Practice location:
  • Phone: 201-532-6212
  • Fax:
Mailing address:
  • Phone: 201-532-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16391
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: