Healthcare Provider Details

I. General information

NPI: 1184528259
Provider Name (Legal Business Name): THIRD STONE HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PONDEROSA TRL
DURANGO CO
81303-7511
US

IV. Provider business mailing address

74 PONDEROSA TRL
DURANGO CO
81303-7511
US

V. Phone/Fax

Practice location:
  • Phone: 434-249-1757
  • Fax:
Mailing address:
  • Phone: 434-249-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICHOLAS MCDERMED
Title or Position: THERAPIST
Credential: MA, LPC
Phone: 434-249-1757