Healthcare Provider Details

I. General information

NPI: 1295897163
Provider Name (Legal Business Name): CYNTHIA J ROSA MA, LPC, ATR, CACIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6033 S EUDORA WAY
CENTENNIAL CO
80121-3331
US

IV. Provider business mailing address

6033 S EUDORA WAY
CENTENNIAL CO
80121-3331
US

V. Phone/Fax

Practice location:
  • Phone: 720-899-9190
  • Fax:
Mailing address:
  • Phone: 720-899-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3200
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number176
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number85-150
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: