Provider Demographics
NPI:1306248315
Name:GARCIA, NICANOR ROBERT III
Entity type:Individual
Prefix:
First Name:NICANOR
Middle Name:ROBERT
Last Name:GARCIA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 NW BUCKLIN HILL RD
Mailing Address - Street 2:STE 215
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8358
Mailing Address - Country:US
Mailing Address - Phone:360-337-2222
Mailing Address - Fax:360-850-0211
Practice Address - Street 1:3100 NW BUCKLIN HILL RD
Practice Address - Street 2:STE 215
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8358
Practice Address - Country:US
Practice Address - Phone:360-337-2222
Practice Address - Fax:360-850-0211
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X103K00000X
WACG60152904101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor