Provider Demographics
NPI:1861220725
Name:GARCIA, ELAINE NICOLE (LMHC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:NICOLE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4661 HICKORY STREAM LN
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-7913
Mailing Address - Country:US
Mailing Address - Phone:863-934-9035
Mailing Address - Fax:
Practice Address - Street 1:3000 K VILLE AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4967
Practice Address - Country:US
Practice Address - Phone:863-665-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health