Provider Demographics
NPI:1194176743
Name:GARCIA, YAROSLABA
Entity type:Individual
Prefix:DR
First Name:YAROSLABA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:YARO
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMHC
Mailing Address - Street 1:2167 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-7517
Mailing Address - Country:US
Mailing Address - Phone:239-537-9646
Mailing Address - Fax:
Practice Address - Street 1:12811 KENWOOD LN STE 202
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5646
Practice Address - Country:US
Practice Address - Phone:239-537-9646
Practice Address - Fax:239-236-0866
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101054400Medicaid
FL13842682OtherCAQH