Healthcare Provider Details

I. General information

NPI: 1285086215
Provider Name (Legal Business Name): DASHA KOTALIK LCSW, CACII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SMITH RD
DENVER CO
80239-3232
US

IV. Provider business mailing address

PO BOX 1108
DENVER CO
80201-1108
US

V. Phone/Fax

Practice location:
  • Phone: 720-913-3789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0007722
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09924253
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: