Basic Information
| Provider Information | |||||||||
| NPI: | 1891023818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | |||||||||
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| Credential: | BS, CSAC, PHM-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64537 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532046937 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1225 W MITCHELL ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532043383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143834455 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2009 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 172V00000X | N | Other Service Providers | Community Health Worker | 174H00000X | N | Other Service Providers | Health Educator | 374J00000X | N | Nursing Service Related Providers | Doula | 101YA0400X | 15419-132 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 15419-132 | 01 | WI | STATE OF WISCONSIN | OTHER | 265259 | 01 | WI | STATE OF WISCONSIN | OTHER |