Healthcare Provider Details

I. General information

NPI: 1336884147
Provider Name (Legal Business Name): MEREDITH RACHEL LEIGH KUCYK LSW, MSW, ADDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEREDITH RACHEL LEIGH BIRD

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 COUNTRY CLUB CIR
COLORADO SPRINGS CO
80909-1017
US

IV. Provider business mailing address

2802 COUNTRY CLUB CIR
COLORADO SPRINGS CO
80909-1017
US

V. Phone/Fax

Practice location:
  • Phone: 720-237-7240
  • Fax:
Mailing address:
  • Phone: 720-237-7240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADDC.0000274
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW.0009924574
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: