Provider Demographics
NPI:1215465067
Name:GARCIA, CHRISTIAN JACOB (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JACOB
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4151
Mailing Address - Country:US
Mailing Address - Phone:575-769-2345
Mailing Address - Fax:
Practice Address - Street 1:718 N AVENUE I
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-5834
Practice Address - Country:US
Practice Address - Phone:806-808-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-0239104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker