Healthcare Provider Details

I. General information

NPI: 1932350865
Provider Name (Legal Business Name): PATRICIA ANN HEADLEY CACIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 CHEROKEE ST.
DENVER CO
80204-3632
US

IV. Provider business mailing address

1155 CHEROKEE ST.
DENVER CO
80204-3632
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-3500
  • Fax: 303-436-3520
Mailing address:
  • Phone: 303-436-3500
  • Fax: 303-436-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6459
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: