Healthcare Provider Details

I. General information

NPI: 1518889054
Provider Name (Legal Business Name): CORA RUBAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 TEJON ST
DENVER CO
80211-1813
US

IV. Provider business mailing address

2111 HODGIN ST
GASTONIA NC
28056-8550
US

V. Phone/Fax

Practice location:
  • Phone: 720-515-9083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0024283
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: