Healthcare Provider Details

I. General information

NPI: 1124981493
Provider Name (Legal Business Name): LIVING PROOF RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4345 CHARLESTON DR
COLORADO SPRINGS CO
80916-3037
US

IV. Provider business mailing address

4345 CHARLESTON DR
COLORADO SPRINGS CO
80916-3037
US

V. Phone/Fax

Practice location:
  • Phone: 719-243-1668
  • Fax: 719-243-1668
Mailing address:
  • Phone: 719-243-1668
  • Fax: 719-243-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: COREY CORNELIUS WOODARD
Title or Position: OWNER/ EXECUTIVE DIRECTOR
Credential:
Phone: 719-243-1668