Healthcare Provider Details

I. General information

NPI: 1194151209
Provider Name (Legal Business Name): DAWN LINNAYA WIDHALM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 S QUEBEC ST
CENTENNIAL CO
80111-4628
US

IV. Provider business mailing address

6410 S QUEBEC ST
CENTENNIAL CO
80111-4628
US

V. Phone/Fax

Practice location:
  • Phone: 720-883-1480
  • Fax:
Mailing address:
  • Phone: 720-883-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6071
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5929
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: