Provider Demographics
NPI:1497853311
Name:GARCIA, ALICIA A (PHD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:14188 N 106TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-1762
Mailing Address - Country:US
Mailing Address - Phone:480-609-2855
Mailing Address - Fax:480-609-2852
Practice Address - Street 1:10613 N HAYDEN RD
Practice Address - Street 2:SUITE J-100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5683
Practice Address - Country:US
Practice Address - Phone:480-609-2855
Practice Address - Fax:480-609-2852
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03552103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ861037489OtherTAX ID
75378Medicare PIN