Provider Demographics
NPI:1063955441
Name:GARCIA, MARIZZEL
Entity type:Individual
Prefix:
First Name:MARIZZEL
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9582 PRINCETON GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9709
Mailing Address - Country:US
Mailing Address - Phone:513-346-5640
Mailing Address - Fax:513-346-5644
Practice Address - Street 1:9582 PRINCETON GLENDALE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-9709
Practice Address - Country:US
Practice Address - Phone:513-346-5640
Practice Address - Fax:513-346-5644
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700678101Y00000X
OHC.1600504101YM0800X
OHC.1700679101YM0800X
OHE.1901464-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000OtherLICENSURE BOARD