Healthcare Provider Details

I. General information

NPI: 1225692247
Provider Name (Legal Business Name): MARIE-ANNE ABENROTH LPC; LAC; NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N ELLICOTT HWY # A101
CALHAN CO
80808-8877
US

IV. Provider business mailing address

355 N ELLICOTT HWY # A101
CALHAN CO
80808-8877
US

V. Phone/Fax

Practice location:
  • Phone: 719-749-6211
  • Fax:
Mailing address:
  • Phone: 719-749-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0001850
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0017016
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: