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NPI Code Detail

MEDICARE: MS. CAROLINE HONORA STORK LSW, CCTP, CADC

MEDICARE: MS. CAROLINE HONORA STORK LSW, CCTP, CADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker0009923449CO

General Provider Information

NPI Number : 1003400227
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROLINE HONORA STORK LSW, CCTP, CADC
Provider Business Mailing Address
First Line : 443 HIGHWAY 105
Second Line :
City : PALMER LAKE
State : CO
Zip : 80133-9003
Country : US
Telephone Number : 719-884-0063
Fax Number :
Provider Business Practice Location Address
First Line : 443 HIGHWAY 105
Second Line :
City : PALMER LAKE
State : CO
Zip : 80133-9003
Country : US
Telephone Number : 719-884-0063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2021
Last Update Date : 02/28/2021

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