Basic Information
| Provider Information | |||||||||
| NPI: | 1306415922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ GARZA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ROCIO | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4540 MACK AVE STE B | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217033303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016985665 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13121 BROOKLANE DR | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217421514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017330330 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2021 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LC11946 | MD | N | Behavioral Health & Social Service Providers | Counselor | Professional | 390200000X | LGP9989 | MD | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.