Basic Information
Provider Information | |||||||||
NPI: | 1215193404 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GARCIA | ||||||||
FirstName: | CHRISTINE | ||||||||
MiddleName: | WERNER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MA, LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WERNER | ||||||||
OtherFirstName: | CHRISTINE | ||||||||
OtherMiddleName: | MICHELLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 12150 E BRIARWOOD AVE UNIT 202 | ||||||||
Address2: |   | ||||||||
City: | CENTENNIAL | ||||||||
State: | CO | ||||||||
PostalCode: | 801126755 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7206627862 | ||||||||
FaxNumber: | 7205732862 | ||||||||
Practice Location | |||||||||
Address1: | 12150 E BRIARWOOD AVE UNIT 112 | ||||||||
Address2: |   | ||||||||
City: | CENTENNIAL | ||||||||
State: | CO | ||||||||
PostalCode: | 801126701 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7206627862 | ||||||||
FaxNumber: | 7205732862 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/06/2008 | ||||||||
LastUpdateDate: | 08/03/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/03/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6486 | CO | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.