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Individual

DR. MARK GARCIA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
2620 CENTENARY BLVD, BLDG. #3, SUITE 207, SHREVEPORT, LA 71104-3356
(318) 676-7650
Mailing address
2620 CENTENARY BLVD, BLDG. #3, SUITE 207, SHREVEPORT, LA 71104-3356
(318) 676-7650

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1098
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1098
LIC TO PRACTICE PSYCHOLOGY
LA
Enumeration date
04/04/2014
Last updated
04/04/2014
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