MEDICARE: NICOLE GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPCC.0019538	CO

General Provider Information

NPI Number	:	1306614680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE GARCIA

Provider Business Mailing Address
First Line	:	PO BOX 748465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8465
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W CITY CENTER DR STE 302
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-1030
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	12/15/2023

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Directions to “ NICOLE GARCIA ” Practice Location

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