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General NPI Number Information
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NPI Number | 1902324304
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Entity Type | Individual
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Provider Name | SUSAN MARIE GARCIA LPCA, NCC
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Gender | Female
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 822 OLD WINSTON ROAD SUITE 5
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City | KERNERSVILLE
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State | NC
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Zip | 27284
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Country | US
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Telephone | 336-812-9733
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Fax |
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Provider Business Mailing Address
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Address Line | 3630 CLEMMONS RD UNIT 751
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City | CLEMMONS
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State | NC
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Zip | 27012-0716
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Country | US
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Telephone | 336-655-9818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | A13105
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A13105
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | A13105
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A13105
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License Number State | NC
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