Healthcare Provider Details

I. General information

NPI: 1922252402
Provider Name (Legal Business Name): MARIA GRAZIA DI GIORGIO MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2769 IRIS AVE SUITE #103
BOULDER CO
80304-4405
US

IV. Provider business mailing address

3065 30TH ST #2B
BOULDER CO
80301-1351
US

V. Phone/Fax

Practice location:
  • Phone: 303-544-0889
  • Fax:
Mailing address:
  • Phone: 303-544-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 4102
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: